Pancreas Retransplantation: Ideal Timing and Early and Late Results

Sansalone, C. V.; Maione, G; Rossetti, O.; Aseni, Paolo; Soldano, S.; Roberto, A. De; Civati, G

doi:10.1016/j.transproceed.2006.02.136

Cited by 22 publications

(17 citation statements)

References 7 publications

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“…The increased technical difficulties and the generally more extensive dissection involved with reoperative surgery may explain the higher incidence of surgical complications. Other series have also described a higher incidence of surgical complications associated with pancreas retransplants (14, 15). However, it is important to note that the higher incidence of surgical complications did not result in a higher incidence of technical failure of the graft in the PASPK group.…”

Section: Discussionmentioning

confidence: 99%

Technical failure of the pancreas after SPK transplant: are these patients good candidates for later pancreas retransplant?

Wang

Sturdevant

Kandaswamy

et al. 2007

Clinical Transplantation

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Technical failure of the pancreas graft after a simultaneous pancreas-kidney (SPK) transplant is not uncommon, affecting roughly 10% of SPK recipients. These patients often recover with good kidney function, but have persistent issues related to their diabetes. The aim of this study was to determine if these patients were good candidates for a later pancreas retransplant. Outcomes were compared between 21 PASPK (pancreas after SPK) recipients and 361 recipients of a primary pancreas after kidney (PAK) transplant. Except for kidney graft source, there was no significant difference in the demographic characteristics between these two groups. In general, early surgical complications were more common in PASPK than PAK recipients (47.6% vs. 35.5%, p = 0.15), although the difference was not statistically significant. The incidence of acute rejection was no different between these two groups (28% vs. 33%, p = NS). At three yr post-transplant, patient and pancreas graft survival rates were also no different between the two groups (p = NS). The most common cause for graft loss in both groups was acute or chronic rejection. In conclusion, pancreas retransplant is a viable option for SPK recipients experiencing early technical failure of the pancreas graft. These recipients are not at higher immunologic risk vs. primary PAK recipients.

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Section: Discussionmentioning

confidence: 99%

Technical failure of the pancreas after SPK transplant: are these patients good candidates for later pancreas retransplant?

Wang

Sturdevant

Kandaswamy

et al. 2007

Clinical Transplantation

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“…This facilitates placing the new graft into the same anatomic site as the prior transplant, thereby preserving other sites for possible future transplants. Although some previous studies suggest that immediate retransplantation is associated with similar graft and patient survival as primary transplants (9), others indicate that this approach is associated with a higher incidence of postoperative complications and rejection leading to premature loss of the second graft (10). This study reexamines the efficacy of immediate retransplantation for pancreatic grafts lost during the early postoperative period at a single center.…”

Section: Introductionmentioning

confidence: 89%

“…More recent reports cite technical failure as the most important source of early graft losses (5). Sansalone et al found that immediate retransplantation following technical graft loss in these patients was associated with poorer graft survival compared to delayed retransplantation (10). In particular, of five immediate retransplants (3-11 days), one died from pulmonary embolus following thrombosis of the second graft, one lost the second graft to an enteric anastomotic leak and three lost their grafts to resistant rejection less than 2 years following transplantation.…”

Section: Immediate Pancreas Retransplantationmentioning

confidence: 99%

Immediate Retransplantation for Pancreas Allograft Thrombosis

Hollinger

Powelson²,

Mangus³

et al. 2009

American Journal of Transplantation

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Early pancreas allograft failure most commonly results from thrombosis and requires immediate allograft pancreatectomy. Optimal timing for retransplantation remains undefined. Immediate retransplantation facilitates reuse of the same anatomic site before extensive adhesions have formed. Some studies suggest that early retransplantation is associated with a higher incidence of graft loss. This study is a retrospective review of immediate pancreas retransplants performed at a single center. All cases of pancreas allograft loss within 2 weeks were examined. Of 228 pancreas transplants, 12 grafts were lost within 2 weeks of surgery. Eleven of these underwent allograft pancreatectomy for thrombosis. One suffered anoxic brain injury and was not a retransplantation candidate, one was retransplanted at 3.5 months and nine patients underwent retransplantation 1-16 days following the original transplant. Of the nine early retransplants, one pancreas was lost to heparin-induced thrombocytopenia, one recipient died with function at 2.9 years and the other grafts continue to function at 76-1137 days (mean 572 days). One-year graft survival for early retransplantation was 89% compared to 91% for all pancreas transplants at our center. Immediate retransplantation following pancreatic graft thrombosis restores durable allograft function with outcomes comparable to first-time pancreas transplantation.

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“…Risk of pulmonary embolism associated with early pancreas graft thrombosis is a direct result of the systemic venous drainage so that clots in the portal vein would embolize similarly to a deep venous thrombosis. Sansalone et al also reported their experience of pulmonary embolism following early allograft pancreatectomy and retransplantation, which was probably associated with graft thrombosis. While graft thrombectomy by using Fogarty catheter® (Edwards Lifesciences Corp, San Diego, CA) via the tail‐end of the donor splenic vein has been described by our group and elsewhere , careful assessments of the thrombus with visualization/US is crucial.…”

Section: Discussionmentioning

confidence: 95%

“…Indications for allograft pancreatectomy have not been clearly established, but cause and timing of graft failure, clinical symptoms and candidacy for pancreas retransplantation are all important considerations that must be taken into account . We have previously reported our experience with immediate retransplantation following early graft loss, usually secondary to pancreas allograft thrombosis, and late pancreas retransplantation .…”

Section: Introductionmentioning

confidence: 99%

Allograft Pancreatectomy: Indications and Outcomes

Nagai

Powelson

Taber

et al. 2015

American Journal of Transplantation

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This study evaluated the indications, surgical techniques, and outcomes of allograft pancreatectomy based on a single center experience. Between 2003 and 2013, 47 patients developed pancreas allograft failure, excluding mortality with a functioning pancreas allograft. Early graft loss (within 14 days) occurred in 16, and late graft loss in 31. All patients with early graft loss eventually required allograft pancreatectomy. Nineteen of 31 patients (61%) with late graft loss underwent allograft pancreatectomy. The main indication for early allograft pancreatectomy included vascular thrombosis with or without severe pancreatitis, whereas one recipient required urgent allograft pancreatectomy for gastrointestinal hemorrhage secondary to an arterioenteric fistula. In cases of late allograft pancreatectomy, graft failure with clinical symptoms such as abdominal discomfort, pain, and nausea were the main indications (13/19 [68%]), simultaneous retransplantation without clinical symptoms in 3 (16%), and vascular catastrophes including pseudoaneurysm and enteric arterial fistula in 3 (16%). Postoperative morbidity included one case each of pulmonary embolism leading to mortality, formation of pseudoaneurysm requiring placement of covered stent, and postoperative bleeding requiring relaparotomy eventually leading to femoro‐femoral bypass surgery 2 years after allograftectomy. Allograft pancreatectomy can be performed safely, does not preclude subsequent retransplantation, and may be lifesaving in certain instances.

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Pancreas Retransplantation: Ideal Timing and Early and Late Results

Cited by 22 publications

References 7 publications

Technical failure of the pancreas after SPK transplant: are these patients good candidates for later pancreas retransplant?

Technical failure of the pancreas after SPK transplant: are these patients good candidates for later pancreas retransplant?

Immediate Retransplantation for Pancreas Allograft Thrombosis

Allograft Pancreatectomy: Indications and Outcomes

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