Pancreas Retransplantation

Abstract

Pancreas retransplantation is a safe procedure with acceptable graft survival that should be proposed to diabetic patients who have lost their primary graft.

Outcomes of pancreas retransplantation in patients with pancreas graft failure

“…Not surprisingly graft survival was better after simultaneous kidney–pancreas retransplantation compared with single pancreas retransplantation (80 versus 63 per cent after 5 years). The less favourable outcome following single pancreas retransplantation has also been described by other groups, and is already known for primary single pancreas transplantation8, 9, 11. One suggested reason for this is that a pancreatic graft is more immunogenic than, for example, a combined kidney graft.…”

“…Even though these data have to be taken into consideration, the discrepancy between the UNOS data and the favourable outcomes published by selected high‐volume centres highlights the importance of referring patients to experienced centres8, 11, 31. Surgical experience and meticulous immunological monitoring are crucial in patients selected for retransplantation.…”

“…Single pancreas transplantation, either as pancreas after kidney transplantation or as pancreas transplantation alone, is performed less frequently and harbours a greater immunological and surgical risk, resulting in less favourable outcomes6, 7, 8. According to data published by the International Pancreas Transplantation Registry9, the 5‐year graft survival rate is 73 per cent for simultaneous kidney–pancreas transplantation, 53 per cent for pancreas transplantation alone and 64 per cent for pancreas after kidney transplantation.…”

“…The highly controversial results form the basis of the ongoing debate regarding indications and recommendations for pancreas retransplantation. On the one hand, some consider the high morbidity associated with pancreas retransplantation to be unacceptable; on the other hand, the progression of serious long‐term complications of insulin‐dependent diabetes mellitus may justify pancreas retransplantation in selected patients8, 10, 11.…”

Islet-after-failed-pancreas and pancreas-after-failed islet transplantation: Two complementary rescue strategies to control diabetes

“…[10][11][12] After PTX or ITX failure, potential options include return to exogenous insulin, or consideration of re-transplantation. Pancreas re-transplantation may offer similar graft survival to primary transplantation but in highly selected patients 13 and likewise, ITX re-transplantation may restore insulin-independence after graft dysfunction in >80% for selected patients. 14 However, recent large series demonstrated significant decrease in graft survival after second compared to primary PTX, 15,16 and similarly ITX outcomes may also be associated with dismal graft function after re-transplantation.…”