376 
SURGERY AND TRANSPLANTATION 
Bile \ 
dud^ \i 
ligated 
Inferior 
Pancreaticoduodenal 
artery 
5up. 
Mesenteric 
artery •••anai 
vein 
Figure 1. — The donor operation for segmental pan- 
creatic allografting in the dog. The pancreas is li- 
gated and divided at its neck. The portal vein-supe- 
rior mesenteric vein comples is excised en bloc and 
the splenic artery is preserved for anastomosis. The 
arterial supply to the graft is the celiac artery. (Re- 
printed by permission of Dr. Merkel). 
by Merkel interspersing the pancreas into the 
blood supply to and from the hind leg so that 
patency of the vascular connections was assured 
by the large hind limb flow^^'^^ (Figures 1 
and 2). 
An early observation which was borne out in 
the human experience indicated the trans- 
planted pancreas was most sensitive to manipu- 
lation and, following revascularization, points 
of trauma became hemorrhagic. Therefore, a 
"No Touch" technique was adopted for extirpa- 
tion. The donor pancreas was ligated and di- 
vided at the neck and only the distal portion 
transplanted on a vascular pedicle consisting of 
the portal and superior mesenteric veins and 
the celiac and splenic arteries. 
In the previously pancreatectomized or allox- 
anated recipient, both the iliac artery and vein 
were divided between vascular clamps. Anasto- 
moses were carried out between the donor por- 
tal vein and recipient vena cava, the donor su- 
perior mesenteric vein and the recipient distal 
iliac vein, the donor celiac axis and the host's 
v5plenic /'/^ 
artery 
vein 
Hypogastric v. 
Figure 2. — The recipient operation for segmental pan- 
creatic allografting in the dog. The portal vein of the 
graft is anastomosed to the proximal iliac artery at 
the vena cava and the superior mesenteric vein is 
connected distally to the iliac vein near the take oif 
of the hypogastric vein. (Reprinted by permission of 
Dr. Merkel). 
proximal iliac artery, and the recipient's distal 
iliac artery with the donor splenic artery (Fig- 
ure 3) . This technique was remarkably etfective 
and abolished thrombosis as a cause of failure. 
These studies also showed that either conven- 
tional immunosuppression with Imuran and 
prednisone, or antilymphocyte serum could re- 
sult in prolonged graft survival (Table I). Sur- 
vival of up to 98 days was obtained with this 
method (Figure 4) . 
The anatomic and histopathologic conse- 
quences of pancreatic allografting were similar 
to those encountered in renal allotrans- 
plantation. The gross appearance of the reject- 
ing pancreas is much like the rejecting kidney 
(Figures 5 and 6). The gland is edematous and 
Table I 
Group 
Survival 
Vascular 
Thrombosis 
Leakage 
of Pancratic 
Secretions 
State of Graft 
A. Poncreoleclomized 
Dogs 
(15 Dogs) 
1 5.6c). 
(9- 55d.) 
0 
2 
53 % Functioning 
at Dealli 
B. Alloxinoted 
Dogs 
(15 Dogs) 
31. Od 
(2-98d) 
0 
0 
40 % Functioning 
ol Deolh 
