Pancreas transplant complications

Background

• Pancreatic transplant indicated to treat Type 1 diabetes with ESRD and/or brittle diabetes and/or hypoglycemia unawareness
• Usually done as combined kidney-pancreas transplant
• Grafted pancreas either bladder-drained (safer procedure, more late complications) or enterically drained

Immunosuppressant Medications

• Balance between immune suppression, rejection and susceptibility to infection
• Typical regimen includes: calcineurin inhibitor + antimetabolite + steroid
  • Calcineurin inhibitor
    • Cyclosporine
    • Tacrolimus
  • Steroids
    • Prednisone/Prednisolone
  • +/- Antimetabolite
    • Azathioprine
    • Mycophenolate mofetil (MMF)

Complications and Clinical Presentation

Surgical Complications

• More prone to surgical/technical complications than other solid transplanted organs
• Graft thrombosis
  • due to low blood flow to pancreas
  • usually in first week post-op
  • Venous thrombosis: swollen, tender graft site, hematuria, lower extremity edema, DVT
  • Arterial thrombosis: often asymptomatic
  • Suspect if sudden increase in insulin requirements or sudden drop in urinary amylase
• arterial pseudoaneurysm, AV fistulas
• Intraabdominal abscess, anastomotic leak
• Bleeding
• Graft pancreatitis (usually early post-op), fistulae, pseudocysts

Rejection

• 30% of pancreas transplant recipients will have rejection during first year
• Signs/symptoms: graft tenderness, unexplained fever, hyperglycemia (late finding)

Bladder-drained Pancreas

• irritation from pancreatic enzymes to urothelium → cystitis, hematuria, dysuria
• heavy loss of bicarbonate in pancreatic secretions→ dehydration, metabolic acidosis

Infection

• Increased risk of opportunistic/severe infections due to anti-rejection meds
• Fever and other classic features may be absent due to immunosuppression

Medication Adverse Effects

• Prednisone
  • Hyperglycemia, psychiatric symptoms, poor wound healing, edema, hypertension
• Tacrolimus, cyclosporine
  • Neurotoxicity, tremor, hyperkalemia, nephrotoxicity, hypertension, hyperglycemia, gout
• Mycophenolate
  • Cytopenias, GI distress
• Azathioprine
  • Cytopenias, pancreatitis, hepatitis

See Also

• Transplant complications

References

Authors

Claire, Amr Badawy, Ross Donaldson, Neil Young, Michael Holtz