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Breaking the Third Rule of Surgery: Pancreas Transplantation at UTMB

Jul 7, 2022, 14:39 PM by Melanie Connolly, UTMB Surgery

The three “rules” of surgical training, often jokingly repeated by surgery residents to each other, are: 

  • Eat when you can 

  • Sleep when you can 

  • Don’t mess with the pancreas 

The UTMB (University of Texas Medical Branch) Transplant Team breaks this “third rule of surgery” regularly, with the intention to dramatically improve their patients’ quality of life. 

The pancreas does not tolerate being manipulated, which makes it a tricky organ to transplant. Because of this, our UTMB transplant surgeons utilize the “no-touch technique” of pancreas procurement. The pancreas is removed from the donor patient with what Dr. Trine Engebretsen, Transplant Surgeon and Assistant Professor at the Department of Surgery, describes as “handles.” The donor patient’s spleen and a portion of the duodenum remain attached, and the pancreas is removed without being touched. After the pancreas is removed, the spleen is disconnected, the duodenum is shortened, and a y-graft donor vessel is attached prior to transplantation. 

Dr. Engebretsen discussed the changes to health and wellbeing that occur in patients who have had a pancreas transplant:  

“The transplant specialty is already unique because of the lifelong impact you can have on someone’s quality of life and projected life expectancy. We see that clearly in immediate-need cases, like kidney and liver transplants. The pancreas transplant procedure is particularly special because we can see such a dramatic change in someone’s quality of life. These are patients who may have had 10 or more years of insulin injections, blood sugar checks, they may have hypoglycemic unawareness: this can keep people from being able to drive, hold a job, or be alone because they might black out and could be harmed when that happens. This procedure can be completely life-changing.” 

The UTMB Transplant Team can transplant an isolated pancreas, but our recipient patients who see the greatest benefit are those who have both diabetes and end-stage renal disease. Because of this, the UTMB Transplant Team most commonly completes “simultaneous heterotopic grafts.” In these situations, patients receive a concurrent kidney and pancreas transplant, and the patient’s original organs are not removed. The implantation of both a kidney and the pancreas together allows the new organs to synergistically benefit each other. This means that many recipients of a pancreas transplant have 3 kidneys and 2 pancreata. 

These are complex procedures, and their successful completion takes a team effort that is centered around the patient. The Transplant Medical Review Board at UTMB includes professionals from social work, nursing, nutrition, pharmacy, nephrology, surgery, and more. There is a lot of multidisciplinary coordination that must take place to make this happen. Dr. Engebretsen is excited to see the transplant program at UTMB grow safely, sustainably, and with the health of patients at the forefront of everything they do. Even if they do have to “break the rules” to make it happen.