ª 2010 John Wiley & Sons A/S.

Clin Transplant 2011: 25: 4–12 DOI: 10.1111/j.1399-0012.2010.01381.x

Review Article

Segmental live donor pancreas

transplantation: review and critique of
rationale, outcomes, and current
recommendations
Boggi U, Amorese G, Marchetti P, Mosca F. Segmental live donor pancreas Ugo Boggia, Gabriella Amoreseb,
transplantation: review and critique of rationale, outcomes, and current Piero Marchettic and Franco
recommendations. Moscad
Clin Transplant 2011: 25: 4–12. ª 2010 John Wiley & Sons A/S. a
Divisione di Chirurgia Generale e Trapianti
nellÕUremico e nel Diabetico, bDivisione di
Abstract: We herein review and comment rationale, outcomes, and current
Anestesia e Rianimazione 1, cDivisione di
recommendations for live donor (LD) pancreas transplantation (PTx).
Diabetologia e Metabolismo and dDivisione di
Segmental (spleen-preserving) pancreas donation is associated with a rela-
Chirurgia Generale Universitaria 1, Università di
tively small risk of complications. The risk of death, presumably not lower
Pisa e Azienda Ospedaliero-Universitaria,
than that of LD nephrectomy, cannot be estimated yet because of the lack
Pisana, Pisa, Italy
of reported donor fatalities. The prevalence of type 2 diabetes, in non-obese
donors, is expected not to exceed 3%. The risk of type 1 diabetes does not
seem to increase. Segmental LD PTx, when compared to cadaver PTx,
Key words: live donor – outcome – pancreas
continues to carry a slightly higher risk of technical failure, but the rate of
transplantation – recommendations – segmental
immunologic failure is consistently lower. Overall, LD PTx should be
pancreas graft
considered in all patients with a live kidney donor (owing to the shortage of
cadaver kidneys, the superlative outcome of LD kidney transplantation, Corresponding author: Ugo Boggi, MD, Divisione
and the immunologic advantages of simultaneous pancreas–kidney trans- di Chirurgia Generale e Trapianti nellÕUremico e
plantation from the same donor). The immunologic advantages of LD PTx nel Diabetico, Azienda Ospedaliero Universitaria
are emphasized in highly sensitized recipients of solitary PTx who, with Pisana, Ospedale di Cisanello, via Paradisa 2,
cadaver donation, wait the longest time and face the poorest outcome. 56124 Pisa, Italy.
Furthermore, LD allows recipient pre-conditioning and/or pair donor Tel.: +39 050 543695; fax: +39 050 543692;
exchange. In conclusion, LD PTx may offer significant advantages to well- e-mail: u.boggi@med.unipi.it
selected diabetic recipients. LDs are exposed to relatively small risks.
Conflict of interest: None.

Accepted for publication 22 October 2010

The use of organs from live donors (LD) is an
important component of modern transplantation
medicine (1). As shown in kidney transplantation
(2), the use of organs from LD not only increases
the number of transplants performed yearly, but
also provides the designated recipients with
excellent and durable graft function (3). Further,
the fixed date of transplantation from LD allows
transplantation across compatibility barriers
either directly (4–10) or through the implementa-
tion of specific matching programs, such as
paired-kidney-exchange-programs (10–13).
LD, however, are exposed to the risks of surgery
and, depending on which graft is donated, to the
additional risk of organ-specific long-term mor-
bidity (14–16). These concerns have probably
limited the wider use of LD for pancreas trans-
plantation (PTx), despite the facts that the pan-
creas was the first extrarenal organ to be
successfully transplanted (17), and LD represent
the only realistic opportunity for PTx in highly
sensitized recipients (15, 16). As a matter of fact, of
the 20 000 PTx and more performed since 1966,
<1% have come from LD (15, 16).

4

We herein review and comment current infor-
mation on PTx from LD including a summary of
the recent ethical and medical guidelines issued by
the ethics committee (EC) of the Transplantation
Society (TTS) (1, 14).
Rationale for PTx from LDs
The rationale of LD PTx has evolved over time.
LDs were used early on for PTx to reduce the rates
of immunologic graft loss. Until 1984, in the pre-
cyclosporine era, this purpose was achieved mostly
in pancreas after kidney (PAK) recipients. In the
cyclosporine era, lower rejection rates were
recorded for both PAK and pancreas transplant
alone recipients. Using these primordial immuno-
suppressive regimens, the effect of improved HLA
matching from LD was so relevant that long-term
graft survival was superior to that achieved with
deceased donors, despite initial higher technical
failure rate (15, 16).
With the introduction of tacrolimus and myco-
phenolate mofetil, and their combined use, immu-
nologic graft loss of deceased donor PTx
diminished dramatically (18–21) making the immu-
nologic advantage of LD no longer as remarkable
as it was previously.
Considering that for solitary pancreas grafts,
there is no stringent graft shortage (22–24) and that
the technical failure rate is lower for whole pancre-
aticoduodenal grafts than for segmental grafts, the
historical incentives for using LD for solitary PTx
have mostly waned. In this recipient category, the
use of LDs is currently recommended if candidates
are highly immunized (panel-reactive antibody
>80%) with limited probabilities of receiving a
deceased donor graft, if they must avoid high-dose
immunosuppression or have a non-diabetic identical
twin or a six-antigen-matched sibling (15).
The waiting time for simultaneous kidney–
pancreas (SPK) transplant from deceased donors
is usually from three to five yr (depending on blood
type and geographic area). As patients with diabe-
tes deteriorate rapidly on dialysis (25, 26), only a
minority of them are able to wait this long while
remaining sufficiently healthy for a transplant.
Thus, shortage of deceased donor kidneys is the
main factor limiting our capability to timely trans-
plant potential SPK recipients (27). Under these
circumstances, the use of LD should not be
restricted to specific categories of SPK recipients,
but rather pursued in each patient with a suitable
LD kidney candidate. Kidney transplantation
alone (KTA) from LD offers considerable
advantages in diabetics, because it reduces their
mortality of approximately two-thirds offering a
Live donor pancreas transplantation
10-yr patient survival of 67% (26). However, if the
underlying diabetes is not corrected by PTx, there is
a high recurrence of diabetic nephropathy, as high
as 100% in four yr (28, 29), associated with a higher
risk of long-term mortality (30–34). Therefore, for
SPK candidates who have a live kidney donor,
there are two main possibilities: to undergo LD
KTA first followed by cadaver PAK transplant, or
to receive simultaneously a kidney and a segmental
pancreas from the same LD (SLPK). As the
standard of care for type 1 diabetics with end-stage
renal failure is to receive a SPK transplant, shortage
of deceased donor kidney grafts provides a sound
rationale for using LD for SLPK transplant.
Additional advantages of SLPK transplantation
are seen in patients highly sensitized against HLA.
Indeed, if one of these unfortunate recipients has a
negative cross-match with an LD, or can be
converted to a negative cross-match by pre-condi-
tioning techniques, this would probably be his/her
only actual chance of receiving a dual-graft trans-
plant. Considering that the results of KTA are
inferior to those of SPK, in terms of either graft
function (28, 29) or long-term recipient survival
(30–34), the option of SLPK transplantation should,
at least, be presented to recipient–donor pairs when
the recipient is highly sensitized.
Actually, there is a third transplant option for
diabetics in end-stage renal failure that combines an
LD kidney with a deceased donor pancreas
(namely, simultaneous cadaver pancreas live donor
kidney transplantation; SCPLK) (31–37). SCPLK
was first performed in the 1980s at the University of
Minnesota (35) and has been recently revived at
other institutions (36, 37). This type of transplant,
when compared with LD KTA plus PAK, carries
the advantage of obviating the need for two
operations as well as for a second course of
induction treatment. However, when compared to
SLPK, SCPLK has increased organizational needs
and less favorable immunologic perspectives. Orga-
nizational issues that are specific to SCPLK include
around the clock availability of a kidney procure-
ment team (nowadays, usually a laparoscopic pro-
curement team) (37–40) until a suitable deceased
pancreas donor is found (36, 37). If the recipient is
highly sensitized, this search can last years. Immu-
nologically, as the two grafts come from different
donors, the pancreas is a solitary graft. Although
preliminary experiences show short- and mid-term
insulin independence rates equivalent to those
achieved after SPK (36, 37), the perspectives for
long-term pancreas allograft survival in SCPLK are
substantially unknown. Additionally, SCPLK is the
only transplant in which two genetically different
grafts are transplanted simultaneously into the
5
Boggi et al.

same recipient, whose immunologic response might renal failure are reported in Tables 1–3. In sum-
be either smoothed or enhanced by alloantigen mary, the potential advantages of using LD for
overload. These interactions have not been fully PTx are the following:
investigated yet.
1. Improved HLA matching (more important for
When balancing between KTA with sequential
solitary PTx, especially if recipients are highly
PAK and SLPK, it should be remembered that the
sensitized or should avoid high-dose immuno-
former option requires two operations and two
suppression);
courses of induction therapy, with their incipient
2. Reduced rates of delayed graft function (with its
complications, and puts the recipient at risk of
inherent implications on long-term graft sur-
immunization against HLA as a consequence of the
vival and level of graft function);
first transplant, thus potentially complicating the
3. Opportunity for recipient pre-conditioning,
search for a pancreas donor and/or compromising
allowing for ABO and/or cross-match incom-
the immunologic outlook of the solitary pancreas
patible PTx;
allograft. Accordingly, the pancreas is rejected
4. Avoidance of high-dose immunosuppression in
more frequently after PAK than after SPK (41).
patients who otherwise would face serious
Specific advantages and disadvantages of trans-
problems (e.g., patients with a history of
plant options for diabetic patients with end-stage

Table 1. Kidney (and pancreas) transplant possibilities, from deceased donors, for diabetic recipients with end-stage renal failure

Advantages Disadvantages

KTA vs. SPK, SLPK, SCPLK, and LD KTA plus PAK vs. SPK, SLPK, SCPLK, and LD KTA plus PAK
Lower surgical risk Persistence of diabetes (poorer metabolic control, recurrent
Correction of uremia in patients with high-risk diabetes nephropathy, progression of extrarenal complications, reduced
unsuitable for more complex surgery life expectancy)
No risk on live donors vs. SPK
Increased wait time (usually, no priority over other recipient
categories)
vs. SLPK, SCPLK, and LD KTA
Increased wait time (lack of direct donation from live donor)
vs. LD KTA
Higher delayed graft function rate
Shorter graft half-life/poorer renal function
Shorter life expectancy
KTA plus PAK vs. (LD) KTA vs. SPK, SLPK, and SCPLK
Correction of diabetes Higher surgical risk (repeat surgery)
vs. SPK, SLPK, and SCPLK Higher immunosuppression burden (repeat induction therapy)
Correction of diabetes in post-uremic recipients, initially Potential hazard on kidney graft function (>>creatinine clearance
deemed too sick for dual grafting <70 mL/min)
vs. SLPK, SCPLK, and LD KTA vs. SPK, and SLPK
No risk on live donors Higher immunologic risk on the pancreas (solitary graft)
SPK vs. (LD) KTA vs. (LD) KTA
Correction of diabetes Higher surgical risk
Prolonged kidney graft survival Complications on the pancreas graft may have a negative impact
Improved quality of life on function/survival of the kidney graft
Extended life expectancy vs. LD KTA, SLPK, and SCPLK
Longer wait time (usually, several years)
vs. (LD) KTA plus PAK vs. LD KTA, and SLPK
Single operation Longer wait time/lower transplant opportunity if high PRA levels
Single induction therapy Lower probability of six-antigen match
Lower immunologic risk on the pancreas (‘‘sentinel’’ kidney)
vs. SLPK
Lower pancreas technical failure rate
Reduced organizational needs
vs. SCPLK
Lower immunologic risk on the pancreas (‘‘sentinel’’ kidney)
Reduced organizational needs

LD KTA, live donor kidney transplantation alone; KTA, kidney transplantation alone; LD KTA plus PAK, live donor kidney transplantation alone plus pancreas after kidney
transplantation; SPK, simultaneous pancreas–kidney transplantation; SLPK, simultaneous live donor pancreas–kidney transplantation; SCPLK, simultaneous cadaver
pancreas live donor kidney transplantation.

6
 Live donor pancreas transplantation

Table 2. Kidney (and pancreas) transplant possibilities, from live donors, for diabetic recipients with end stage renal failure

Advantages Disadvantages

LD KTA vs. SPK, SLPK, SCPLK, and (LD) KTA plus PAK vs. KTA, KTA plus PAK, and SPK
Lower surgical risk Kidney donor at risk of post-operative and/or long-term
Correction of uremia in patients with high-risk diabetes not fit complications
enough for more complex surgery vs. SPK, SLPK, SCPLK, and (LD) KTA plus PAK
vs. KTA Persistence of diabetes (poorer metabolic control, recurrent
Shorter wait time nephropathy, progression of extrarenal complications,
Usually, better HLA matching reduced life expectancy)
Lower delayed graft function rate
Longer graft half-life/better renal function
Improved life expectancy
Opportunity for ABO and/or cross-match incompatible
transplant
Opportunity for paired donation
vs. SPK, SCPLK, and (LD) KTA plus PAK
(easier) ABO and/or cross-match incompatible transplant
Opportunity for paired donation
SLPK vs. (LD) KTA vs. (LD) KTA, (LD) KTA plus PAK, SPK, and SCPLK
Correction of diabetes Live donor exposed to surgical risks and long-term
Better quality of life consequences of hemipancreatectomy
Extended life expectancy (>>KTA) vs. SPK, and SCPLK
Better HLA matching (KTA) Higher pancreas technical failure rate
vs. (LD) KTA plus PAK Higher rate of pancreatic fistula
Single operation
Single-induction therapy
Lower immunologic risk on the pancreas (‘‘sentinel’’ kidney)
vs. SPK
Shorter wait time
Improved HLA matching
Opportunity for ABO incompatible and/or cross-match
positive transplantation
Opportunity for paired donation (yet to implemented)
vs. SCPLK
Lower immunologic risk on the pancreas (‘‘sentinel’’ kidney)
Lower organizational needs
Improved access to ABO incompatible and/or cross-match
positive transplantation
Opportunity for paired donation (yet to be implemented)

LD KTA, live donor kidney transplantation alone; KTA, kidney transplantation alone; LD KTA plus PAK, live donor kidney transplantation alone plus pancreas after kidney
transplantation; SPK, simultaneous pancreas–kidney transplantation; SLPK, simultaneous live donor pancreas–kidney transplantation; SCPLK, simultaneous cadaver
pancreas live donor kidney transplantation.

malignancy having an identical twin or a six-
antigenmatched donor);
5. Elimination of waiting time (especially relevant
for SPK recipients) with its detrimental effects
on either quality or expectancy of life of patients
with diabetes, because of the accelerated pro-
gression of complications promoted by uremia
and dialysis;
6. Expansion of donor pool (relevant for SPK
recipients).
Additionally, construction of a list of incompat-
ible live donor–recipient pairs (either ABO incom-
patibility or positive cross-match) could allow the
implementation of exchange programs (42), such
as those in force for the kidney (10–13).
Occasionally, a segmental pancreas graft
procured from an LD may be used for islet
transplantation (17, 35, 43–45). This procedure,
although first performed in 1977 (17), has not been
fully developed yet and is currently investigational.
Available information suggests that a critical mass
of highly viable islets can be prepared from a
hemipancreas specimen obtained from an LD (46)
and that such an islet graft can restore normogly-
cemia and possibly insulin independence in
patients with type 1 diabetes (43).
World experience
Segmental PTx
As of September 2005, a total of 146 segmental LD
PTx have been performed worldwide. Most of this
experience was earned at a single institution (the
University of Minnesota; n = 130). The remaining

7
Boggi et al.
Advantages
LD KTA vs. (LD) KTA
plus PAK Correction of diabetes
vs. SPK, SLPK, and SCPLK
Correction of diabetes in post-uremic
recipients, initially deemed too sick
for dual grafting
SCPLK vs. (LD) KTA
Correction of diabetes
Prolonged kidney graft survival
(vs. KTA)
Better quality of life
Extended life expectancy (?)
vs. (LD) KTA plus PAK
Single operation
Single-induction therapy
vs. SPK
Shorter wait time
Expansion of (kidney) donor pool
vs. SLPK
Lower pancreas technical failure rate
LD KTA, live donor kidney transplantation alone; KTA, kidney transplantation alone; LD KTA plus PAK, live donor
kidney transplantation alone plus pancreas after kidney transplantation; SPK, simultaneous pancreas–kidney
transplantation; SLPK, simultaneous live donor pancreas–kidney transplantation; SCPLK, simultaneous cadaver
pancreas live donor kidney transplantation.
16 operations were performed in the USA
(Chicago, n = 9), Japan (Chiba, n = 4; Osaka,
n = 1), and South Corea (Seoul, n = 2). No
donor death was reported (14).
Overall, most of the available results refer to the
University of Minnesota experience. At that Insti-
tution, between 1978 and 1993, 78 solitary PTx
from LD were performed (77 from genetic relatives
and 1 from a spouse). Of the 77 relatives, 10 were
identical twins, 29 were HLA identical siblings, and
38 were mismatched relatives. With respect to
recipients, actuarial patient survival in technically
successful LD recipients was 100% at one yr and
95% at 10 yr. A comparison of technically suc-
cessful solitary LD and concurrent cadaveric
pancreas Tx showed that graft survival rates were
63% vs. 45% at one yr and 55% vs. 35% at
three yr. Although there was a higher technical
failure rate with LD PTx, there was a lower
rejection rate with this latter than with deceased
donor transplants (47).
In the SPK series at the University of Minnesota
from March 1994 to August 2000, 32 transplants
were from LD. With respect to recipients, com-
parison of LD and cadaveric SPK transplants
showed actuarial patient survival was 100% vs.
8
Table 3. Kidney (and pancreas) transplant
Disadvantages possibilities, from mixed (live and deceased)
donor source, for diabetic recipients with end-
vs. (LD) KTA, SPK, SLPK, and SCPLK stage renal failure
Higher surgical risk (dual surgery)
Higher immunosuppression burden
(dual-induction therapy)
Potential hazard on kidney graft function
(>>creatinine clearance <70 mL/min)
vs. SPK, and SLPK
Higher immunologic risk on the pancreas
(solitary graft)
vs. (LD) KTA
Higher surgical risk
Complications on the pancreas graft may
have a negative impact on function/
survival of the kidney graft
vs. LD KTA, and SLPK
HLA mismatch from two different donors
simultaneously
Difficult (precluded?) transplantation from
ABO incompatible and/or cross-match
positive donors
Higher organizational needs
vs. SPK, and SLPK
Higher immunologic risk on the pancreas
(solitary graft)
96% at one yr and graft survival for the pancreas
was 86% vs. 81% at the same time point (22).
Islet transplantation
Experimental studies in rat models have shown
that brain death reduces the yields of islet isolation
and results in lower islet viability both in vitro and
in vivo (48). Jung et al. (45) showed that also in
humans brain death decreases beta-cell viability
and yield of islet cell mass. The use of LD could
therefore improve the outcome of islet transplan-
tation.
The worldwide experience with allogeneic LD
islets is currently limited to three cases (17, 35,
43–45). At the University of Minneosta, two LD
islet transplants were performed more than 25 yr
ago, one in 1977 and one in 1978 (17). A third LD
islet transplant was performed on January 19, 2005
in Kyoto, Japan, rendering a 27-yr-old daughter of
the 56-yr-old mother insulin-independent 22 d
post-transplant (43). Despite the favorable short-
term outcome of the latter case, it should be
acknowledged that islet transplantation is yet an
imperfect technique achieving insulin independence
in a limited percentage of recipients and mostly in

the very insulin-sensitive patients. Furthermore,
insulin independence as possibly achieved by islet
transplantation is often short lived, even though
glucose metabolism is improved more durably,
thus protecting recipients against troublesome
hypoglycemia (49). Considering that in most
Western countries, there is no shortage of deceased
pancreas donors (22–24) and that insulin indepen-
dence is now being reported with single grafts from
cadaver donors (50), the use of LD for islet
transplants should be considered only in extremely
well-selected patients. In societies, such as Japan,
in which transplantation of deceased donor organs
is not fully developed yet, there are probably more
ethical reasons to explore this new frontier of
modern transplant medicine.
The Vancouver Forum (1, 14)
The Vancouver Forum (Vancouver, Canada, Sep-
tember 15 and 16, 2005) was an international
conference of transplant physicians, surgeons, and
allied health professionals organized under the
auspices of the EC of the TTS. The forum was
attended by over 100 transplant specialists, repre-
senting many countries from around the world. The
purpose of the Vancouver Forum was to develop an
international standard of care for the live lung,
liver, pancreas, and intestinal organ donor (14).
The Vancouver Forum provided an ethics state-
ment (1) and organ-specific medical recommenda-
tions (14) that were prepared by dedicated study
groups and subsequently reported in a plenary
session for discussion and approval.
Summary of the ethics statement of the Vancouver Forum
(1)
Organs from LD are an important component of
modern transplantation, and their use should be
regulated by the same ethical principles established
for live kidney donation. As transplantation of
extrarenal organs from deceased donors offers real
benefits to potential recipients and eliminates the
risks to healthy LD, full exploitation of cadaver
donation should not be limited by the development
of transplantation from LD.
The physical and psychosocial welfare of healthy
donors must be contextualized in the needs of
the recipient and the impact of his/her illness
upon the donor. Accordingly, PTx from LD
should be performed when the aggregate benefits
to the donor–recipient pair surpass the risks to the
donor–recipient pair. Potential LD should receive
competent, exhaustive, repetitive, and specific
information.
Live donor pancreas transplantation
Information currently available for PTx from
LD is admittedly limited. Individual transplant
teams as well as the entire transplant community
carry the responsibility to collect and share data on
LD outcomes.
Summary of the medical recommendations of the
Vancouver Forum for LD PTx (14)
Patients with type 1 diabetes who are suitable
candidates for deceased donor PTx may be also
evaluated for LD PTx. ABO donor–recipient
compatibility and negative cross-match are pre-
ferred but not mandatory.
Evaluation of LD should begin with a thorough
endocrinologic work-up. If the results of all met-
abolic tests are satisfactory, the long-term risk of
diabetes in the donor is expected to be <3%.
Avoiding obesity or overweight is very important
to reduce the risk of long-term diabetes.
The risk of death of LD cannot be accurately
estimated because of the limited number of trans-
plants reported and lack of known fatalities, but it
cannot be expected to be lower than that of live
kidney donation.
The segmental pancreas graft may be procured
either in open or laparoscopic approach. The hand-
assisted laparoscopic technique is associated with
all the traditional advantages of minimally invasive
surgery (51) and, as such, is expected to become
predominant. The segmental pancreas graft, includ-
ing the entire tail and part of the body, is procured
en bloc with splenic vessels. The left gastroepiploic
vessels and the short gastric vessels should be
preserved to provide collateral blood supply to the
spleen (Fig. 1). Splenectomy may be required in up
to 15% of LD because of ischemia or bleeding. LD
should therefore receive, at least two wk prior
to surgery, vaccination against pneumococcus,
hemophilus B, and meningococcus.
Specific surgical complications, mostly related to
management of the pancreatic stump and general
post-operative complications are expected to occur
in some 5% of LD. A rare, late, complication
caused by ablation of splenic vessels is bleeding
from esophagogastric varices. In these patients, a
splenectomy is required and is curative.
Conclusions
LD PTx represents an additional transplant pos-
sibility that should be offered to selected recipients
in centers of excellence.
In highly sensitized patients, LD may be the only
actual opportunity for PTx, as search for a
compatible deceased donor may last longer than
9
Boggi et al.
Fig. 1. Spleen-preserving distal pancreatectomy. The segmen-
tal graft, consisting of pancreatic tail and part of body, is
procured en bloc with splenic artery and vein. Collateral blood
flow from gastric vasculature supplies the spleen through the
short gastric vessels. The inferior mesenteric vein, when
draining into the splenic vein, is ligated and divided close to the
inferior border of the pancreas; otherwise, when joining the
superior mesenteric vein, it should be preserved.
recipient suitability for PTx. Furthermore, as
shown by the kidney, accurate donor screening
has high organizational needs, requires close
cooperation between different organ procurement
organizations and is rarely successful (52, 53). The
availability of an LD, on the contrary, makes PTx
immediately possible.
LD PTx is not absolutely contraindicated even in
case of ABO incompatibility and/or cross-match
positivity because of the possibility of recipient pre-
conditioning (4–8). Thus, the risk of early or late
graft failure, because of technical or immunologic
reasons, should not be viewed as a main disincen-
tive to LD PTx, as it is clearly surpassed by the
medical and psychosocial consequences of never
receiving the needed graft. To the best of our
knowledge, no PTx has been performed so far in the
setting of pair exchange, but LD would make it
possible. A proposal for the implementation of a
national pair exchange program is being considered
by the kidney–pancreas committee of UNOS (42).
For patients with uremic diabetes in need of an
SPK transplant, the availability of a live kidney
donor conveys clear advantages over remaining on
the waiting list. As long as an LD is available, and
suitable, SLPK may be an option carrying
potential and consistent advantages over a KTA
followed by a PAK. The final decision should be
based on individual circumstances.
Development of LD PTx programs should be
based on sound multidisciplinary backgrounds.
10
Particular expertise is required for metabolic eval-
uation of LD as well as for providing them with
comprehensive and well-intelligible information.
Donor hemipancreatectomy, by either open or
laparoscopic approach, requires specific surgical
knowledge and skills. There is indeed a clear
evidence that surgical and medical complications
of pancreatic resection are influenced by annual
hospital volume (54, 55) and number of operations
performed by the individual surgeon (56, 57),
although most of these estimates refer to pancre-
atoduodenectomy (55–57). Centers willing to
embark upon LD PTx should have sound experi-
ence in both PTx and pancreatic resections.
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