Fig. 7.8. Annual number of pancreas transplants according to exocrine drainage method.

kidney is based on the recipient left iliac vessels. Both organs may be transplanted through a midline incision and placed intraperitoneally.

Occasionally, it is necessary to consider placement of pancreas transplant based on the left iliac vessels because of a previously placed kidney transplant on the right side. In this sequential pancreas-after-kidney transplant procedure, the in-tra-abdominal approach is used. The pancreas is typically drained into the bladder if a pancreas transplant alone or pancreas-after-kidney transplant is performed in order to utilize measurement of urinary amylase as a method of detecting rejection. However, some programs have had good experience with enteric drainage of the pancreas transplant alone utilizing other markers for rejection, such as clinical signs and symptoms of pancreas graft pancreatitis and serum amylase or lipase levels coupled with biopsy.

F. Complications of Pancreas Transplantation

Surgical complications are more common after pancreas transplantation compared to kidney transplantation. Non-immunological complications of pancreas transplantation account for graft losses in 5-10% of cases. These occur commonly within 6 months of transplant and are as an important etiology of pancreas graft loss in SPK transplantation as acute rejection.

1. Thrombosis

Vascular thrombosis is a very early complication typically occurring within 48 hours, and usually within 24 hours of the transplant. This is generally due to venous thrombosis of the pancreas portal vein. The etiology is not entirely defined but is believed to be associated with reperfusion pancreatitis and the relatively low-flow

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