Validation of the Back-table Graft Arterial Anastomosis Between the Splenic Artery and Superior Mesenteric Artery: Arterial Complications After a 21-year Single-center Experience of Pancreas Transplantation.

Abstract

To determine the role of the arterial splenomesenteric anastomosis (ASMA) vascular reconstruction technique in terms of arterial vascular complications in pancreas transplantation (PT) recipients. The ASMA technique was first described in 1992 by the Hospital Clínic Barcelona group. Regardless that the iliac Y-graft technique is the most frequently used worldwide, evidence of arterial complications and implications of using a different back-table reconstruction is conspicuously absent in the literature. Descriptive review of 407 PTs performed at a single center (1999-2019) by analyzing the type of arterial reconstruction technique, focusing on ASMA. The end points were the management of arterial complications and long-term patient and graft survival. ASMA was performed in 376 cases (92.4%) and a Y-graft in 31 cases (7.6%). A total of 34 arterial complications (8.3%) were diagnosed. In the ASMA group (n=30, 7.9%), they comprised 15 acute thrombosis, 4 stenosis, 1 pseudoaneurysm, and 10 diverse chronic arterial complications, whereas in the Y-graft group (n=4, 12.9%), 3 acute thrombosis and 1 chronic artery-duodenal fistula occurred. Graft salvage was achieved in 16 patients (53.3%) from the ASMA group and in 2 (50%) from the Y-graft. After a median follow-up of 129.2 (IQR 25-75%, 77.2-182) months, the overall graft and patient survival for the whole cohort at 1, 5, and 10 years were 86.7%, 79.5%, and 70.5%, and 98.5%, 95.3%, and 92.5%, respectively. The ASMA proves to be a safe and more easily reproducible technique and could therefore be considered a safe alternative vascular reconstruction procedure to the Y-graft in the PT population.