Medical and Surgical Management of the Failed Pancreas Transplant

Michael J. Casey, Naoka Murakami, Song Ong, Joel T. Adler, Neeraj Singh, Haris Murad, Sandesh Parajuli, Beatrice P. Concepcion, Michelle Lubetzky, Martha Pavlakis, Kenneth J. Woodside, Arman Faravardeh, Arpita Basu, Ekamol Tantisattamo, Amtul Aala, Angelika Gruessner, Darshana Dadhania, Krista Lentine, Matthew Cooper, Ronald F. ParsonsTarek Alhamad

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

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.

Original languageEnglish
Pages (from-to)E1543
JournalTransplantation Direct
Volume10
Issue number1
DOIs
StatePublished - Dec 12 2023

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