Einstein (São Paulo) (Mar 2006)
Solitary pancreas retransplant: Study of 22 cases
Abstract
Objective: To present our experience with pancreas retransplantin patients previously submitted to simultaneous pancreas-kidneytransplant, pancreas after kidney transplant and pancreastransplant alone. Methods: Between January/1996 and December/2005, 330 pancreas transplants were performed: 308 primarytransplants and 22 (6%) retransplants of solitary pancreas. Thefollowing variables were analyzed: patient age; time elapsedbetween the first and the second transplant; causes of loss of thefirst graft; technical characteristics of the transplant andretransplant and the criteria for selecting donors for retransplant.These clinical data were submitted to statistical analysis. Results:The mean age of patients was 34.3 years and the mean elapsedtime between the first and second transplant was 19.3 months.The causes of the first graft loss were venous (8; 35%) and arterial(5; 23%) thrombosis, chronic rejection (4; 18%), ischemia/reperfusion injury (2), reflux pancreatitis (1), primary non-function(1) and sepsis (1). A second transplant was performed in thesame iliac fossa in 16 patients (72%). Venous drainage wasperformed in the iliac vein in 16 patients (72%), in the inferior venacava in 5 patients (22%) and in the portal vein in one patient. 6 allbladder drainage was the technique used in 18 (82%) cases andenteric drainage, in 4 patients (18%). Immunosuppressive regimenapplied to all cases was quadruple therapy with antilymphocyteinduction, tacrolimus, mycophenolate mofetil and steroids. Therewas one early death due to sepsis. One-year patient and pancreasgraft survival rates for retransplants were, respectively, 95% and85%. There was no additional risk for removing the pancreas graftat retransplant. Conclusion: Pancreas retransplant was technicallyfeasible in all cases and results similar to those described in theliterature were found for primary pancreas transplant.
