| 1. |
Okabe Y, Kitada H, Miura Y, Nishiki T, Kurihara K, Kawanami S, Terasaka S, Kaku K, Noguchi H, Sugitani A, Tanaka M, Pancreas transplantation: a single-institution experience in Japan, Surg Today, 43(12):1406-1411, 2013.04, PURPOSE:
We herein report our experience with pancreas transplantation in 26 patients at a single institution in Japan between August 2001 and December 2011.
METHODS:
We reviewed the medical records of 26 pancreas transplantations performed in our institute.
RESULTS:
The early complications (within 2 weeks) included one graft venous thrombosis, one arterial thrombosis, and two reoperations for bleeding. Of the 26 pancreas transplant recipients, five lost pancreas graft function. Of 24 simultaneous pancreas-kidney recipients, three lost kidney graft function due to noncompliance. The patient, pancreas, and kidney survival rates were 100, 96 and 93 % at 1 year; 100, 80 and 93 % at 5 years; and 100, 67 and 68 % at 10 years, respectively. Of all these complications, venous thrombosis after pancreas transplantation was the most critical.
CONCLUSIONS:
As the largest series of pancreas transplantations in a single institution in Japan, our series yielded better results than the worldwide data recorded by the International Pancreas Transplant Registry. Routine postoperative anticoagulation therapy is not necessary for the prevention of graft thrombosis if sufficient fluid infusion is strictly controlled and the graft blood flow is frequently monitored. When graft thrombosis occurs, both early detection and appropriate intervention are extremely important if the pancreas graft is to survive.
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| 2. |
Noguchi H, Nakagawa K, Ueki K, Tsuchimoto A, Kaku K, Okabe Y, Nakamura M, Response to Treatment for Chronic-active T Cell-mediated Rejection in Kidney Transplantation: A Report of 3 Cases, Transplant Direct, 10.1097/TXD.0000000000001079
, 6(12):e628, 2020.04. |
| 3. |
Sanshiro Hatai, Keizo Kaku, Shinsuke Kubo, Yu Sato, Hiroshi Noguchi, Yasuhiro Okabe, Naoki Ikenaga, Kohei Nakata, Masafumi Nakamura, Reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy to prevent left-sided portal hypertension: a report of two cases, Surgical Case Reports, 10.1186/s40792-023-01773-x, 9(1):200, 2023.04, Background:
Left-sided portal hypertension including gastric venous congestion may be caused by ligating the splenic vein during pancreaticoduodenectomy with portal vein resection or total pancreatectomy. The usefulness of reconstruction with the splenic vein has been reported in such cases. However, depending on the site of the tumor and other factors, it may be impossible to leave sufficient length of the splenic vein, making anastomosis difficult. We report two patterns of reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy to prevent left-sided portal hypertension.
Case presentation:
The first patient was a 79-year-old man who underwent pancreaticoduodenectomy for pancreatic cancer. The root of the splenic vein was infiltrated by the tumor, and we resected this vein at the confluence of the portal vein. Closure of the portal vein was performed without reconstruction of the splenic vein. To prevent left-sided portal hypertension, we anastomosed the right gastroepiploic vein to the middle colic vein. Postoperatively, there was no suggestion of left-sided portal hypertension, such as splenomegaly, varices, and thrombocytosis.
The second case was a 63-year-old woman who underwent total pancreatectomy for pancreatic cancer. The splenic vein-superior mesenteric vein confluence was infiltrated by the tumor, and we resected the portal vein, including the confluence. End-to-end anastomosis was performed without reconstruction of the splenic vein. We also divided the left gastric vein, left gastroepiploic vein, right gastroepiploic vein, and right gastric vein, which resulted in a lack of drainage veins from the stomach and severe gastric vein congestion. We anastomosed the right gastroepiploic vein to the left renal vein, which improved the gastric vein congestion. Postoperatively, imaging confirmed short-term patency of the anastomosis site. Although the patient died because of tumor progression 8 months after the surgery, no findings suggested left-sided portal hypertension, such as varices. Reconstruction with the right gastroepiploic vein during pancreaticoduodenectomy and total pancreatectomy is useful to
prevent left-sided portal hypertension.. |
