Introduction: Intestinal transplantation provides a therapeutic option for patients with irreversible intestinal failure and complications of total parenteral nutrition. For technical reasons, the pancreas has been transplanted en bloc with the multivisceral allografts. Here, we report the advantages and complications related to the pancreas inclusion in the multivisceral (MV) and modified multivisceral (MMV) allografts.

Methods: Retrospective analysis of 64 recipients of MV and MMV allografts transplanted between 2013-2018 was performed at the Miami Transplant Institute. Pancreas was included in all of the 64 recipients. We recorded the pre-transplant history of diabetes, its type and treatment, and the development of new-onset diabetes post-transplant. Pre- and post-transplant acute pancreatitis was documented and recorded. Graft and patient survival due to pancreatitis was also recorded.

Results: The five recipients with pre-transplant history of diabetes (type 2 in four recipients, and type 1 in one recipient) demonstrated clinical cure from diabetes with no need for insulin or oral hypoglycemic drugs at 3, 6 and 12 post-transplant months. The incidence rate of post-transplant acute necrotizing pancreatitis in recipients with no prior history of acute pancreatitis was 3% (2/60) while none of the recipients with pre-transplant history of acute pancreatitis developed it post-transplant (0/4). Acute pancreatitis progressed to fatal necrotizing pancreatitis in 50% (1/2) of the recipients who developed post-transplant acute pancreatitis. No technical problems related to the pancreas were encountered.

Conclusion: Pancreas inclusion in MV and MMV allografts brought the cure for recipients with pre-transplant history of diabetes and those with a past history of acute pancreatitis, as well.