Although a wide variety of techniques are employed in transplant centres performing simultaneous pancreas─kidney transplantation (SPK), most centres use the intraperitoneal approach for graft placement. The pancreas is transplanted to a heterotopic location, commonly the right iliac fossa, while the kidney is transplanted to the contralateral iliac fossa. The intraperitoneal approach results in fewer collections of peripancreatic fluid and wound complications. An alternative approach involves extraperitoneal and ipsilateral placement of both grafts (Jiang et al., 2014).
One approach to arterial anastomosis is conjoining the donor superior mesenteric artery and splenic artery to a Y graft of the recipient external or common iliac artery. If systemic drainage is provided, the donor portal vein is anastomosed to the external iliac vein.
An alternative approach is anastomosis of the donor portal vein to the superior mesenteric vein, if portal venous drainage is available. This was originally performed to reduce lipid dysregulation and rejection rates, but studies have shown very little difference in overall long-term outcomes and between systemic and portal drainage (Jiang et al., 2014).