Xu Y, Zhang JY, Yu XH, Xie Y, Cao Y, Zhao J. Vascular allocation between liver and pancreas allografts: A retrospective single-center study. World J Gastrointest Surg 2026; 18(4): 117684 [DOI: 10.4240/wjgs.v18.i4.117684]
Corresponding Author of This Article
Jie Zhao, Chief Physician, Department of Kidney Transplantation, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. zjsecond@aliyun.com
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Gastroenterology & Hepatology
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Case Control Study
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Apr 27, 2026 (publication date) through Apr 24, 2026
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World Journal of Gastrointestinal Surgery
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Xu Y, Zhang JY, Yu XH, Xie Y, Cao Y, Zhao J. Vascular allocation between liver and pancreas allografts: A retrospective single-center study. World J Gastrointest Surg 2026; 18(4): 117684 [DOI: 10.4240/wjgs.v18.i4.117684]
World J Gastrointest Surg. Apr 27, 2026; 18(4): 117684 Published online Apr 27, 2026. doi: 10.4240/wjgs.v18.i4.117684
Vascular allocation between liver and pancreas allografts: A retrospective single-center study
Yang Xu, Jun-Yan Zhang, Xing-Hui Yu, Yan Xie, Yu Cao, Jie Zhao
Yang Xu, Xing-Hui Yu, Yu Cao, Jie Zhao, Department of Kidney Transplantation, Tianjin First Central Hospital, Tianjin 300192, China
Jun-Yan Zhang, Department of Liver Transplantation, First Central Hospital of Tianjin Medical University, Tianjin 300380, China
Yan Xie, Department of Liver Transplantation, Tianjin First Center Hospital, Tianjin 300192, China
Author contributions: Xu Y was responsible for collected data, and wrote the paper; Zhang JY, Yu XH, and Xie Y were the main persons in charge of the surgery of orthotopic liver transplantation; Zhang JY, Xie Y, Cao Y, and Zhao J were the main persons in charge of the surgery of simultaneous pancreas-kidney; Cao Y was analyzed data, and assisted with the data interpretation; Zhao J designed the research and helped with manuscript revisions; all of the authors read and approved the final version of the manuscript to be published.
Supported by Beijing Medical Award Foundation, No. YXJL-2025-0483-0212; Tianjin Science and Technology Plan Project, No. 24JCZDJC01380; and the Tianjin Key Medical Discipline Construction Project, No. TJYXZDXK-3-006A.
Institutional review board statement: The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethics Committee of Tianjin First Central Hospital, No. YC-BY-LC-2025-025.
Informed consent statement: All participants provided informed consent.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Data sharing statement: The data that support the findings of this study are available from the authors upon request.
Corresponding author: Jie Zhao, Chief Physician, Department of Kidney Transplantation, Tianjin First Central Hospital, No. 24 Fukang Road, Nankai District, Tianjin 300192, China. zjsecond@aliyun.com
Received: December 15, 2025 Revised: January 10, 2026 Accepted: February 25, 2026 Published online: April 27, 2026 Processing time: 132 Days and 15.7 Hours
Abstract
BACKGROUND
The global shortage of organs from deceased donors has led transplant centers to maximize the utilization of each donation after brain death. Concomitant liver procurement and simultaneous pancreas-kidney (SPK) transplantation are increasingly performed; however, the celiac trunk and its branches are shared by both grafts. Effectively dividing these vessels without compromising arterial inflow presents a significant technical challenge, and no consensus exists regarding the optimal strategy for vessel allocation and reconstruction.
AIM
To analyze graft outcomes following arterial allocation between the liver and pancreas, with particular focus on the technique of gastroduodenal artery reconstruction.
METHODS
In this single-center, retrospective study, 395 adult liver transplantations were performed at our hospital from January 2018 to June 2019. Propensity score matching was used to balance covariates, resulting in a cohort of 102 patients. This group included 34 patients who underwent liver transplantation with concurrent pancreas procurement [pancreas-using group (PUG)] and 68 patients without pancreas procurement [non-PUG (NPUG)]. Clinical data and outcomes of both groups, as well as 34 patients who underwent SPK transplantation during the same period, were analyzed.
RESULTS
No significant differences were observed in preoperative, intraoperative characteristics or postoperative surgical complications between the two groups (P > 0.05). On days 2, 3, and 4 post-surgery, PUG patients exhibited lower alanine aminotransferase (183.62 ± 103.91 U/L, 130.69 ± 65.19 U/L, 90.42 ± 34.01 U/L) and aspartate aminotransferase (97.33 ± 46.38 U/L, 47.55 ± 21.71 U/L, 34.03 ± 16.2 U/L) levels compared to NPUG patients (P < 0.05). The proportion of patients achieving normal total bilirubin levels within 7 days was significantly higher in the PUG group (73.5%) compared to the NPUG group (48.5%) (P < 0.05). Graft survival rates at 6 months, 12 months, and 18 months were 97.1%/95.5%, 97.1%/95.5%, and 97.1%/95.5% in the PUG/NPUG groups, respectively. Patient survival rates were identical in both groups (97.1% at all time points). For SPK transplantation patients, kidney/pancreas/patient survival rates were 96.2%/100%/100%, 96.2%/100%/100%, and 96.2%/90%/100% at 6 months, 12 months, and 18 months, respectively.
CONCLUSION
The allocation of donor blood vessels between the liver and pancreas does not adversely affect the prognosis of either graft when the pancreas is used. The described technique offers a novel approach to arterial reconstruction in SPK transplantation.
Core Tip: In donation-after-brain-death donors, the celiac axis was allocated to the pancreas graft, with the gastroduodenal artery reconstructed for the pancreas. This strategy enabled successful liver and pancreas-kidney transplantation without increasing the risk of hepatic artery thrombosis or graft loss. Additionally, it facilitated faster normalization of liver enzymes, providing a safe vascular sharing approach for multi-organ procurement.
