Chapter 31. Pancreas Transplantation

• May be performed in diabetic patients with end-stage renal disease either as simultaneous pancreas-kidney (SPK) transplantation, or as pancreas-after-kidney (PAK) transplantation.
  • Pancreas transplantation has minimal impact on immunosuppression.
• Nonuremic patients with type 1 diabetes usually receive pancreas transplantation alone (PTA).
  • Risk of immunosuppression is added to the surgical risk.

Absolute

• Untreated or recent malignancy.
• Active or chronic infection.
• Inability to comply with postoperative immunosuppression and follow-up.

Relative

• Advanced extrarenal complications of diabetes (coronary artery disease).
• Evidence of insulin resistance (type 2 diabetes, insulin requirements > 1 unit/kg, BMI > 30).

• For both donor and recipient procedures:
  • The patient should be supine.
  • The abdomen is entered through a midline incision.

• Nothing by mouth until return of bowel function.
• Exogenous insulin should not be necessary.
  • Exceptions: cases of delayed graft function or use of high-dose steroids for treatment of rejection.

• Enteric drainage is associated with leak, peritonitis, and abscess.
• Bladder drainage is associated with urethritis or cystitis, and dehydration.