Medical and Surgical Management of the Failed Pancreas Transplant

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

doi:10.1097/TXD.0000000000001543

Transplantation Direct (Jan 2024)

Medical and Surgical Management of the Failed Pancreas Transplant

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

Affiliations

Michael J. Casey, MD, MS: 1 Division of Nephrology, Medical University of South Carolina, Charleston, SC.
Naoka Murakami, MD, PhD: 2 Division of Renal Medicine, Brigham and Women Hospital, Boston, MA.
Song Ong, MD: 3 Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL.
Joel T. Adler, MD, MPH: 4 Division of Transplant Surgery, University of Texas at Austin, Austin, TX.
Neeraj Singh, MD: 5 Willis Knighton Health System, Shreveport, LA.
Haris Murad, MD: 6 Section of Nephrology, The Aga Khan University, Medical College, Pakistan.
Sandesh Parajuli, MD: 7 Division of Nephrology, University of Wisconsin, Madison, WI.
Beatrice P. Concepcion, MD: 8 Section of Nephrology, University of Chicago, Chicago, IL.
Michelle Lubetzky, MD: 9 Division of Nephrology, University of Texas at Austin, Austin, TX.
Martha Pavlakis, MD: 10 Division of Nephrology, Beth Israel Deaconess, Boston, MA.
Kenneth J. Woodside, MD: 11 Gift of Life Michigan, Ann Arbor, MI.
Arman Faravardeh, MD: 12 Sharp HealthCare, San Diego, CA.
Arpita Basu, MD, MPH: 13 Division of Renal Medicine, Emory University, Atlanta, GA.
Ekamol Tantisattamo, MD: 14 Division of Nephrology, University of California Irvine, Orange, CA.
Amtul Aala, MD: 10 Division of Nephrology, Beth Israel Deaconess, Boston, MA.
Angelika C. Gruessner, PhD: 15 Division of Nephrology, SUNY Downstate, Brooklyn, NY.
Darshana M. Dadhania, MD, MS: 16 Division of Nephrology, Weill Cornell Medicine, New York, NY.
Krista L. Lentine, MD, PhD: 17 Division of Nephrology, SSM Health Saint Louis University Transplant Center, St. Louis, MO.
Matthew Cooper, MD: 18 Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI.
Ronald F. Parsons, MD: 19 Division of Transplant Surgery, University of Pennsylvania, Philadelphia, PA.
Tarek Alhamad, MD, MS: 20 Division of Nephrology, Washington University in St Louis, St. Louis, MO.

DOI: https://doi.org/10.1097/TXD.0000000000001543
Journal volume & issue: Vol. 10, no. 1
p. e1543

Abstract

Read online

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.

Published in Transplantation Direct

ISSN: 2373-8731 (Online)
Publisher: Wolters Kluwer
Country of publisher: United States
LCC subjects: Medicine: Surgery
Website: http://journals.lww.com/transplantationdirect/Pages/default.aspx

About the journal