Medical and Surgical Management of the Failed Pancreas Transplant

Author:

Casey Michael J.1ORCID,Murakami Naoka2,Ong Song3,Adler Joel T.4,Singh Neeraj5,Murad Haris6,Parajuli Sandesh7,Concepcion Beatrice P.8,Lubetzky Michelle9,Pavlakis Martha10,Woodside Kenneth J.11,Faravardeh Arman12,Basu Arpita13,Tantisattamo Ekamol14,Aala Amtul10,Gruessner Angelika15,Dadhania Darshana16,Lentine Krista17,Cooper Matthew18,Parsons Ronald F.19,Alhamad Tarek6

Affiliation:

1. Division of Nephrology, Medical University of South Carolina, Charleston, SC.

2. Division of Renal Medicine, Brigham and Women Hospital, Boston, MA.

3. Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.

4. Division of Transplant Surgery, University of Texas at Austin, Austin, TX.

5. Willis Knighton Health System, Shreveport, LA.

6. Division of Nephrology, Washington University in St Louis, St. Louis, MO.

7. Division of Nephrology, University of Wisconsin, Madison, WI.

8. Section of Nephrology, University of Chicago, Chicago, IL.

9. Division of Nephrology, University of Texas at Austin, Austin, TX.

10. Division of Nephrology, Beth Israel Deaconess, Boston, MA.

11. Department of Surgery/Transplantation Section, University of Michigan, Ann Arbor, MI.

12. Sharp HealthCare, San Diego, CA.

13. Division of Renal Medicine, Emory University, Atlanta, GA.

14. Division of Nephrology, University of California Irvine, Orange, CA.

15. Division of Nephrology, SUNY Downstate, Brooklyn, NY.

16. Division of Nephrology, Weill Cornell Medicine, New York, NY.

17. Division of Nephrology, Saint Louis University, St. Louis, MO.

18. Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.

19. Department of Surgery/Division of Transplantation, Emory University, Atlanta, GA.

Abstract

Despite the continued improvements in pancreas transplant outcomes in recent decades, a subset of recipients experience graft failure and can experience substantial morbidity and mortality. Here, we summarize what is known about the failed pancreas allograft and what factors are important for consideration of retransplantation. The current definition of pancreas allograft failure and its challenges for the transplant community are explored. The impacts of a failed pancreas allograft are presented, including patient survival and resultant morbidities. The signs, symptoms, and medical and surgical management of a failed pancreas allograft are described, whereas the options and consequences of immunosuppression withdrawal are reviewed. Medical and surgical factors necessary for successful retransplant candidacy are detailed with emphasis on how well-selected patients may achieve excellent retransplant outcomes. To achieve substantial medical mitigation and even pancreas retransplantation, patients with a failed pancreas allograft warrant special attention to their residual renal, cardiovascular, and pulmonary function. Future studies of the failed pancreas allograft will require improved reporting of graft failure from transplant centers and continued investigation from experienced centers.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Transplantation

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