30 years of history, evolution, and surgical outcomes of pancreas transplants in a single Australian national pancreatic transplant unit.

Background: The first pancreas transplant in Australia was performed at Prince Henry's Hospital in 1984 (which subsequently relocated to Monash Medical Centre in 1992) in the setting of a successful pancreas transplant reported from the University of Minnesota in 1966.¹ This study is aimed at reviewing the evolution of surgical technique in pancreas transplants and the surgical outcomes.

Methods: All pancreas transplants were reviewed from 1992 to 2022. The evolution of surgical technique for pancreas transplants were collected. Outcomes include graft associated complications such as graft thrombosis rate, pancreas graft survival rate, and length of stay.

Results: Forty-four pancreas transplants were done from 1992 to 2001, following that from 2002 to 2022 that number increased to 236 transplants. Venous drainage went from systemic to portal and subsequently reverted to systemic with modification, directly into the inferior vena cava (IVC). The rate of Early pancreatic allograft thrombosis (EPAT) in the institution was (3/18, 17% Common iliac vein (CIV), 3/19, 16% External iliac vein (EIV) and 1/7, 14% Superior Mesenteric Vein (SMV) from 1992 to 2001 and subsequently reduced to 7/119, 5.9% (IVC.) 5/19, 23.3% (CIV), 6/23, 26.1% (EIV), and 10/75, 13.3% (SMV) after modification. The average length of stay of patients in the first cohort was 18.1 days and the subsequent group was 15.5 days. Finally, pancreatic graft survival rates were 77.3% 1-year graft survival and 54.6% 5-year graft survival from 1992 to 2001 and 93.5% 1-year graft survival and 80.6% 5-year graft survival from 2002 to 2022.

Conclusion: Pancreas transplants are complex and technically demanding procedures that should be performed within a specialized unit.