Retransplantation in the diabetic patient with a pancreas allograft.
BACKGROUND: Retransplantation has been considered a risk factor for both postoperative complications and diminished graft survival, especially in diabetic patients. METHODS: A retrospective survey was performed of a consecutive case series of 196 pancreas transplants in 186 diabetic patients. All patients underwent whole organ pancreas transplantation with bladder drainage. RESULTS: A total of 33 pancreas transplants (17%) in 30 patients were performed after previous transplant. The mean interval between transplants was 3.9 years. At the time of retransplantation, 16 patients had concomitant procedures. Venous extension grafts were used in 10 patients. The mean length of initial hospital stay was 19.5 days, and mean hospital charges were approximately $125,000. The incidences of rejection, infection, and operative complications were 61%, 67%, and 45%, respectively. Patient survival was 90%, kidney graft survival was 82%, and pancreas graft survival was 61% after a mean follow-up of 29 months. Complete rehabilitation was achieved in 73% of cases. CONCLUSIONS: Pancreas transplantation after previous transplant is a challenging but safe treatment that often requires concomitant procedures, the use of vascular extension grafts, and atypical placement of the allograft. However, the good results justify an aggressive policy of retransplantation in the diabetic patient either with a failed allograft or functioning kidney transplant.
Stratta, RJ; Lowell, JA; Sudan, D; Jerius, JT
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