Pancreatic Transplant

Pancreatic transplant is performed for IDDM, and commonly occurs conjunction with renal transplant for diabetic nephropathy. Major post-operative considerations include:

Pancreatic transplant occurs in three primary groups:

• Simultaneous pancreas-kidney
  May be deceased donor or living-related donor.
• Pancreas after kidney
  Pancreatic transplant for a prior renal transplant recipient.
• Lone pancreatic transplant

An overview of post-operative management of the kidney transplant patient is covered under ?sec-icu_renal_tx.

• Comorbidities:
  • ESRD
  • Diabetes
  • Diabetic complications
    • CAD
    • PVD
• Pancreatic function
  • Pancreatic exocrine drainage
    • Enteric
      Majority of cases. Considerations:
      • ↓ Metabolic derangements
    • Bladder
      Minority of cases. Considerations:
      • Rejection can be monitored with urine amylase
      • ↑ Risk of urological complications
  • Peripancreatic fluid collections
  • Venous thrombosis
    High risk (~10%) due to low venous flow.
• Immunosuppression

Indications

Improves quality of life and may ↓ mortality in patients who have:

• ESRD
• IDDM
  Generally T1DM.

Contraindications

Principles

Practice

• Optimise pancreatic function
  • Avoid hypervolaemia
  • Aggressive glycaemic monitoring

Resuscitation:

Specific therapy:

• Pharmacological
• Procedural
• Physical

Supportive care:

Q1H BSL measurement is recommended in the early post-operative course.

• C
  • Judicious volume management
    Keep low CVP to maximise venous drainage/minimise venous oedema.
• D
  • Glycaemic control
    Insulin production generally occurs shortly after graft reperfusion. Exogenous insulin will be required, and then rapidly weaned as the graft begins functioning.
  • Amylase measurement
• G
  • Exocrine secretion management
• H
  • Thromboprophylaxis
    

Disposition:

Preventative:

Complications

• C
  • MI
    May be silent.
• Infective
  • Sepsis
    ↑ Risk due to combination of immunosuppression and hyperglycaemia.

Key Studies

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References

1. Birch M, Sikka R, Belani K. Critical care of the kidney, pancreas, and kidney–pancreas transplant recipient. In: Pretto, Jr. EA, Biancofiore G, DeWolf A, Klinck JR, Niemann C, Watts A, et al., editors. Oxford Textbook of Transplant Anaesthesia and Critical Care [Internet]. Oxford University Press; 2015 [cited 2023 Oct 10]. p. 153–64.
2. Bindi ML, Biancofiore G, Pasquini C, Lugli D, Amorese G, Bellissima G, et al. Pancreas transplantation: problems and prospects in intensive care units. MINERVA ANESTESIOLOGICA. 2005;71(5).