Pancreas-Kidney Transplantation for Intensivists: Perioperative Care and Complications

Abstract

Simultaneous pancreas-kidney transplantation is a therapeutic option for type I diabetics with end-stage renal disease. It aims to correct the uremic state, to normalize glucose hemeostasis, and to ameliorate diabetic complications. Careful donor-recipient selection and meticulous intra-operative and postoperative care will substantially impact recipient morbidity. An understanding of the technical aspects of the surgical procedure and its metabolic and immunological consequences is necessary to successfully manage a pancreas-kidney transplant recipient, many of whom are nursed in intensive care units. A successful outcome is predicted in early recognition of technical complications and aggressive management of rejection to achieve the current 1-year graft survival rates of 75% for pancreas transplants and 84% for kidney transplants.

Pancreatic Transplantation: Evaluation and Management

“…The majority of deaths were due to cardiovascular disease and usually occurred more than 3 months after discharge from the hospital. The number of pancreas transplants performed with enteric drainage is increasing, with more than 50% of cases since 1998 compared to 30% in 1994-1997 [28][29][30][31][32]. In the recent past, SKP from a living related donor is gaining popularity [33][34][35][36][37].…”