Pancreas transplant complications


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


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

Bladder-drained Pancreas


  • 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




See Also

External Links