Preoperative risk evaluation

Abstract

Evaluation for pancreas transplantation is an important issue to minimize the risk of the patients for perioperative and postoperative complications. This is especially important in transplant recipients with a diabetic background, who are by definition 'high-risk patients' for transplantation.

Modern indications for referral for kidney and pancreas transplantation

“…Probably, the single most important aspect of recipient selection is the overall assessment of cardiovascular risk, burden and reserve because untreatable cardiac disease is an absolute contraindication to transplant [47][48][49][50][51][52][53][54][55][56][57]. The cardiac status of each candidate must be assessed carefully because significant (and silent) coronary artery disease is not uncommon in this population.…”

“…The cardiac status of each candidate must be assessed carefully because significant (and silent) coronary artery disease is not uncommon in this population. The cardiac evaluation consists of a noninvasive functional assessment such as an exercise or a pharmacological stress test in addition to echocardiography [47][48][49][50][52][53][54][55]57]. Some centers mandate coronary angiography in all potential PTx candidates, whereas at other centers, it is reserved for specific indications, such as age older than 45 years, diabetes for age older than 20-25 years, a positive smoking history, longstanding hypertension, previous major amputation due to peripheral vascular disease, history of cerebrovascular disease, pulmonary hypertension, prior cardiac intervention, history of cardiac arrhythmia, valvular disease, or cases in which the history, physical examination, or noninvasive cardiac studies reveal an abnormality [49,50,[52][53][54][55]57].…”

“…A history of previous myocardial infarction, angioplasty, stenting, or coronary artery bypass grafting is not considered an absolute contraindication because excellent outcomes have been reported in patients with previous cardiac interventions or events [50,51,54,56,57]. However, sudden cardiac death, in the absence of significant structural heart disease, continues to be a primary cause of cardiac mortality following PTx [49][50][51][52][53][54][55][57][58][59][60]. In addition to cardiac testing, the presence and severity of peripheral vascular (particularly iliac arterial) disease should be assessed carefully by a noncontrast abdominal and pelvic computerized tomographic scan in combination with duplex ultrasonography of the iliac vessels.…”

Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype

“…In addition to dysmetabolism and progressive diabetic complications, significant psycho-emotional or physical difficulties with insulin therapy are another indication for PTx. However, the most important part of recipient selection is the overall evaluation of cardiovascular disease burden, risk, and functional reserve [44,71,[83][84][85][86][87][88][89][90][91].…”

“…Because significant (and silent) coronary artery disease may occur in this population, the cardiac evaluation includes initially a non-invasive functional examination (echocardiography in combination with either an exercise or a pharmacological stress test) [44,71,[84][85][86][87][88][89][90]. Cardiac catheterization may be required at some centers in all potential SPKT candidates whereas others may reserve it for selected indications [84][85][86][87][88][89][90]. Prior cardiac interventions or history of cardiac events are not necessarily contraindications for PTx because excellent outcomes can still be achieved in these patients [83,[88][89][90][91].…”