Pancreas transplant complications: Difference between revisions

 
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==Background==
==Background==
{{Transplant emergency types}}
[[File:Blausen 0699 PancreasAnatomy2.png|thumb|Pancreatic anatomy]]
*Pancreatic transplant indicated to treat Type 1 [[diabetes]] with ESRD and/or brittle diabetes and/or hypoglycemia unawareness
*Usually done as combined kidney-pancreas transplant
*Grafted pancreas either bladder-drained (safer procedure, more late complications) or enterically drained
{{Immunosuppressant medication complications}}


==Clinical Features==
==Complications and Clinical Presentation==
===Surgical Complications===
*More prone to surgical/technical complications than other solid transplanted organs
*Graft thrombosis
**due to low blood flow to pancreas
**usually in first week post-op
**Venous thrombosis: swollen, tender graft site, hematuria, lower extremity edema, DVT
**Arterial thrombosis: often asymptomatic
**Suspect if sudden increase in insulin requirements or sudden drop in urinary amylase
*arterial pseudoaneurysm, AV fistulas
*Intraabdominal abscess, anastomotic leak
*Bleeding
*Graft [[pancreatitis]] (usually early post-op), fistulae, pseudocysts
===Rejection===
*30% of pancreas transplant recipients will have rejection during first year
*Signs/symptoms: graft tenderness, unexplained [[fever]], [[hyperglycemia]] (late finding)
===Bladder-drained Pancreas===
*irritation from pancreatic enzymes to urothelium → [[cystitis]], [[hematuria]], [[dysuria]]
*heavy loss of bicarbonate in pancreatic secretions→ [[dehydration]], [[metabolic acidosis]]
===Infection===
*Increased risk of opportunistic/severe infections due to anti-rejection meds
*Fever and other classic features may be absent due to immunosuppression
===Medication Adverse Effects===
*Prednisone
**Hyperglycemia, psychiatric symptoms, poor wound healing, edema, hypertension
*Tacrolimus, cyclosporine
**Neurotoxicity, tremor, hyperkalemia, nephrotoxicity, hypertension, hyperglycemia, gout
*Mycophenolate
**Cytopenias, GI distress
*Azathioprine
**Cytopenias, pancreatitis, hepatitis


==Differential Diagnosis==
==Evaluation==
 
==Diagnosis==


==Management==
==Management==
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==See Also==
==See Also==
*[[Transplant complications]]
*[[Transplant complications]]
*[[Neutropenic fever]]
*[[Immunocompromised antibiotics]]


==External Links==
==External Links==
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==References==
==References==
<references/>
<references/>
[[Category:Surgery]]
[[Category:Misc/General]]

Latest revision as of 19:59, 8 March 2021

Background

Pancreatic anatomy
  • Pancreatic transplant indicated to treat Type 1 diabetes with ESRD and/or brittle diabetes and/or hypoglycemia unawareness
  • Usually done as combined kidney-pancreas transplant
  • Grafted pancreas either bladder-drained (safer procedure, more late complications) or enterically drained

Immunosuppressant Medications

Complications and Clinical Presentation

Surgical Complications

  • More prone to surgical/technical complications than other solid transplanted organs
  • Graft thrombosis
    • due to low blood flow to pancreas
    • usually in first week post-op
    • Venous thrombosis: swollen, tender graft site, hematuria, lower extremity edema, DVT
    • Arterial thrombosis: often asymptomatic
    • Suspect if sudden increase in insulin requirements or sudden drop in urinary amylase
  • arterial pseudoaneurysm, AV fistulas
  • Intraabdominal abscess, anastomotic leak
  • Bleeding
  • Graft pancreatitis (usually early post-op), fistulae, pseudocysts

Rejection

  • 30% of pancreas transplant recipients will have rejection during first year
  • Signs/symptoms: graft tenderness, unexplained fever, hyperglycemia (late finding)

Bladder-drained Pancreas

Infection

  • Increased risk of opportunistic/severe infections due to anti-rejection meds
  • Fever and other classic features may be absent due to immunosuppression

Medication Adverse Effects

  • Prednisone
    • Hyperglycemia, psychiatric symptoms, poor wound healing, edema, hypertension
  • Tacrolimus, cyclosporine
    • Neurotoxicity, tremor, hyperkalemia, nephrotoxicity, hypertension, hyperglycemia, gout
  • Mycophenolate
    • Cytopenias, GI distress
  • Azathioprine
    • Cytopenias, pancreatitis, hepatitis

Evaluation

Management

Disposition

See Also

External Links

References