Introduction: Even with recent data, 5-10% of pancreas transplants experience early technical failure. Graft thrombosis is the primary cause of early technical failure, even when only optimal grafts are used, as is the case in Korea. The purpose of this study is to determine whether we may avoid thrombotic graft failure by modifying venous outflow.

Method: Between March 2017 and December 2022, a total of 73 pancreas transplantations were performed. Until May 2019, 31 cases of fence-angioplasty with cadaveric vena cava were performed to graft portal veins (Vena cava group). Since then, a total of 42 aortic interposition grafts have been performed to graft portal veins (Aortic group).

Result: Between the two groups, there was no significant difference in baseline characteristics. Each group had one and two instances of technical failure. Early graft failure rates were 3.2% and 4.7%, respectively (p=1.000), while 1-year graft survival rates were 96.8% and 92.3 %, respectively (p=0.580). Despite the fact that a graft-threatening thrombosis occurred in the vena cava group, neither group, particularly the aorta group, experienced thrombotic graft failure, despite the absence of heparin use.

Conclusion: When the optimal graft is used, the both techniques of modifying venous outflow can prevent the thrombotic graft failure without heparin use.