Pancreas transplant complications: Difference between revisions
Elcatracho (talk | contribs) |
|||
(7 intermediate revisions by 4 users not shown) | |||
Line 1: | Line 1: | ||
==Background== | ==Background== | ||
{{ | [[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 | ==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 | |||
== | ==Evaluation== | ||
==Management== | ==Management== | ||
Line 14: | Line 46: | ||
==See Also== | ==See Also== | ||
*[[Transplant complications]] | *[[Transplant complications]] | ||
*[[Neutropenic fever]] | |||
*[[Immunocompromised antibiotics]] | |||
==External Links== | ==External Links== | ||
Line 19: | Line 53: | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Surgery]] | |||
[[Category:Misc/General]] |
Latest revision as of 19:59, 8 March 2021
Background
- 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
- Balance between immune suppression, rejection and susceptibility to infection
- Typical regimen includes: calcineurin inhibitor + antimetabolite + steroid
- Calcineurin inhibitor
- Steroids
- +/- Antimetabolite
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