*Purpose: Surgical dogma suggests that portal vein extension grafts (PVEGs) in pancreas transplantation should be strenuously avoided, though the evidence-base is lacking. In our unit, at least one surgeon routinely uses a PVEG, while all surgeons will use a PVEG for major technical issues where a transplant could not otherwise be performed. A single-centre retrospective analysis of outcomes was performed to determine if PVEGs were associated with worse outcomes.

*Methods: All pancreases transplanted between 1.1.13-31.5.18 were included. PVEGs were retrospectively coded as routine (rPVEG) or ‘indicated’ (iPVEG). Outcome measures included pancreas PNF, DGF, pancreas death-censored graft survival (DCGS; graft pancreatectomy or return to insulin), and presence of graft thrombosis (combined clinical and radiological, arterial and venous). Standard univariate statistical analyses were applied.

*Results: 156 pancreas transplants were performed (151 SPK), with 52 from DCD donors (33%). PVEG use was common (42 patients (27%)); 31 (74%) were rPVEG and 11 (26%) were iPVEG. There were no significant differences in donor or recipient baseline variables between PVEG and non-PVEG groups, but median pancreas CIT and mean anastomosis times were longer in the PVEG group (730 vs 641 mins, p=0.002; 44 vs 38 mins, p=0.03). There were no significant differences in rates of pancreas PNF (0% vs 2.6%, p=0.29), DGF (2.4% vs 1.8%, p=0.80), or graft thromboses (9.5% vs 7.9%, p=0.74) between the PVEG and non-PVEG groups, respectively. There were no venous thromboses leading to pancreas graft loss in the PVEG group; 5 occurred in the non-PVEG group (p=0.32). There were no statistically significant differences in DCGS between the PVEG and non-PVEG groups (p=0.59) or between non-PVEG, iPVEG and rPVEG groups (p=0.726, see figure).

*Conclusions: The presence of a PVEG makes no clinically relevant difference in graft outcomes after pancreas transplantation in our unit.

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