378 SURGERY AND 
Figure 5. — The rejecting canine pancreatic allograft. 
Note the edema and hemorrhage characteristic of far 
advanced rejection. 
plants and established their response to is- 
chemia and to conventional systemic immuno- 
therapy. 
HUMAN PANCREATIC TRANSPLANTATION 
The first attempt at a vascularized transplant 
of the pancreas for end stage diabetic nephro- 
pathy in the human was carried out by Kelly, 
Lillehei, Merkel, Idezuki and Goetz at the Uni- 
versity of Minnesota on December 17, 
1966.^813 The same principles which had 
proven successful in the dog were employed to 
assure patency of the venous connections (Fig- 
ure 12) . The graft consisted of the body and tail 
of the pancreas distal to the portal vein. The 
duct was ligated and the raw edges were over- 
sewn. The configuration of the human pancreas 
did not allow for similar treatment of the ar- 
terial supply. Hence, the celiac axis alone was 
anastomosed end-to-end to the iliac artery. The 
transplanted pancreas was placed in the left 
iliac fossa and a kidney was transplanted from 
the same donor to the right iliac fossa. Renal 
function was never achieved and, although con- 
trol of the blood sugar was achieved, it was eva- 
nescent. After four or five days, the endocrine 
function of the pancreas ceased. Interestingly, 
the exocrine function of the graft persisted for 
four and one-half months. 
Because of leakage of exocrine secretions 
from the ligated duct, the next patient received 
a pancreatico-duodenal graft. The proximal end 
of the duodenum was oversewn and the distal 
end was fashioned into a mature stoma in the 
left lower quadrant of the abdomen. It was pos- 
sible to observe and biopsy the stomal mucosa 
and collect secretions for analysis. Both renal 
and pancreatic grafts functioned satisfactorily 
in this patient; however, she died of pulmonary 
sepsis four and one-half months following 
transplant. 
This patient interestingly exhibited a rejec- 
FiGURE 6. — The rejecting canine kidney. Compare the 
features with that of the pancreas. There is a much 
thicker capsule on the kidney; however, the organ is 
swollen and edematous with beginning hemorrhages. 
