Graft trimming with LigaSure™ and leak testing with Indigo carmine reduces blood loss significantly after reperfusion in pancreas transplantation.

PURPOSE: Bleeding after graft reperfusion is a significant challenge in pancreas transplantation (PTx). To reduce post-reperfusion bleeding, we developed a modified bench surgery technique, combining a vessel-sealing system (LigaSure™) with indigo carmine (IC) leak testing. This study evaluates the clinical efficacy and safety of this method.

METHODS

We reviewed, retrospectively, 54 consecutive PTx procedures, with (n = 25) or without (n = 29) the novel LigaSure™ plus IC (L + IC) method, performed between 2010 and 2024. Surgical outcomes, postoperative complications, graft loss, and glucose tolerance were compared between the control and L + IC groups. The safety of IC (9.0 µg/mL) for pancreatic islet cells was assessed through in vitro AO/PI staining and glucose-stimulated insulin secretion (GSIS) assays.

RESULTS

The L + IC group showed significantly less post-reperfusion bleeding than the control group (715 mL vs. 360 mL; p = 0.0122). Multivariate analysis identified that L + IC was independently associated with reduced post-reperfusion bleeding (odds ratio 0.2171, p = 0.0171). IC exposure did not impair islet cell viability or function. The HbA1c and C-peptide levels were comparable between the groups.

CONCLUSION

Our novel L + IC bench surgery technique proved safe and effective for reducing bleeding after pancreas graft reperfusion. Further prospective multicenter studies should be carried out to confirm its impact on long-term surgical outcomes.