Pancreas transplant complications: Difference between revisions
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*Signs/symptoms: graft tenderness, unexplained [[fever]], [[hyperglycemia]] (late finding) | *Signs/symptoms: graft tenderness, unexplained [[fever]], [[hyperglycemia]] (late finding) | ||
===Bladder-drained Pancreas=== | ===Bladder-drained Pancreas=== | ||
*irritation from pancreatic enzymes to urothelium | *irritation from pancreatic enzymes to urothelium → [[cystitis]], [[hematuria]], [[dysuria]] | ||
*heavy loss of bicarbonate in pancreatic | *heavy loss of bicarbonate in pancreatic secretions→ [[dehydration]], [[metabolic acidosis]] | ||
===Infection=== | ===Infection=== | ||
*Increased risk of opportunistic/severe infections due to anti-rejection meds | *Increased risk of opportunistic/severe infections due to anti-rejection meds | ||
Revision as of 19:51, 8 February 2017
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