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  • We meet with the patient immediately prior to the procedure to address any pending questions

  • In instances of a combined kidney pancreas, we usually perform the pancreatic implantation prior to the renal one to minimize the pancreas cold ischemic time.

  • In cases of systemic venous drainage (anastomosis to the external iliac vessels),

    • the pancreas is preferably placed on the right lower quadrant

      • allows drainage of exocrine contents into the small bowel or bladder

      • placing the pancreas on the right lower quadrant provides alignment of the iliac vessels and prevents topographic impediments (to the small bowel and bladder) associated with the left/sigmoid colon.

    • The kidney is routinely placed on the left lower quadrant.

    • This sidedness may be altered depending on

      • Surgeon preference

      • Vascular disease involving the iliac vessels and aorta

      • Previous surgeries (transplants, ostomies, scars)

      • Other factors

  • Verify that the correct allograft is available or will be available at the time of implantation

  • The recipient should have adequate venous access – at least two large bore peripheral IV

  • Placement of central venous lines depends on the potential for intra-operative decompensation as well as surgeon preference

  • Placement of arterial lines depends on the potential for intra-operative decompensation as well as surgeon preference

  • Urinary catheter ALWAYS placed

  • We routinely administer oral aspirin prior to and after the procedure.

  • It is also our practice (if possible) NOT to discontinue medications that recipients may have been taking on a routine basis

    • Clopidrogel, oral anticoagulants, and other medications that predispose to hemorrhage can be either continued at the time of surgery or discontinued/reversed prior to the transplant

      • The risk of cardiovascular/thrombotic complications should be balanced with the possibility of bleeding when making this decision.

    • If discontinued, they should be restarted postoperatively as soon as it is considered safe.

  • IV fluids:

    • Combined kidney pancreas transplant

      • We routinely administer 2-4 liters of isotonic crystalloids during the entire procedure.

      • However, such volume can be modified based on physiologic parameters obtained during the surgery

      • Adding potassium to IV fluids is discouraged

    • Isolated pancreas transplant

      • The volume of IV fluids administered is based on the physiologic needs of each individual patient.

  • We routinely maintain sequential compression devices on both lower extremities during the entire case to diminish the incidence of deep venous thromboses.


  • Performed immediately prior to incision after the abdomen has been painted and draped

  • Review all medications given preoperatively.

  • Intravenous antibiotics administered (assuring that they are received within minutes of incision).

  • Other medications administered

    • induction agents,

      • If combined kidney pancreas

        • 500 milligrams solumedrol (or other desired dosage)

        • 25 g mannitol,

        • 100 mg of furosemide

        • (alternatively, diuretics can be infused prior to reperfusion).


  • This is our preferred technique.

FIGURE 103-1

View of the implanted allograft with portal venous output and enteric drainage of exocrine products. Reproduced with permission from Cameron ...

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