Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content +++ CAUSES OF GRAFT LOSS: ++ Thrombosis: 30% Chronic rejection: 20% Acute rejection: 15% +++ REJECTION ++ Acute rejection is characterized by the presence of activated inflammatory cells in the parenchyma, in association with vascular and glandular injury. Chronic rejection is characterized by atrophy and fibrosis of acini, vessels, and ducts. There is currently no rejection serum/plasma marker with satisfactory sensitivity and specificity – urinary amylase levels (in bladder-drained pancreases) are of the best practical value. Biopsy represents the gold standard for diagnosis of pancreas graft rejection. Surrogate markers (e.g., serum amylase levels, serum lipase levels, blood glucose levels, and C-peptide levels) have limited sensitivity and/or specificity. Decreases in urinary amylase (in bladder-drained grafts) are usually consistent with rejection, but could also be due to other etiologies such as drug toxicity and pancreatitis. Acute cellular rejection is usually treated with high-dose steroids with or without anti-thymocyte globulin +++ BIOPSY: ++ 3% incidence of complications 12% incidence of non-diagnosis +++ PANCREATIC GRAFT IMAGING ++ CT scanning and MRI imaging provide complete evaluation of the graft parenchyma, ducts, vessels, anastomoses, and intestinal status. The use of intravenous contrast should be carefully considered particularly in patients who received a simultaneous or previous kidney transplant. Duplex Doppler evaluation can be impaired by the presence of air-filled intestinal loops. The role of angiography is diminished due to CTA/MRA/MRV availability. Percutaneous drainage and other interventions are of great use in addressing specific complications. +++ POTENTIAL COMPLICATIONS ++ In order to prevent unnecessary graft injury, we do every possible effort to minimize cold (preservation) and warm (implantation) ischemic times. The inherent low blood flow of the pancreas makes it prone to thrombosis. Hemorrhage is not an infrequent complication, especially when heparin is administered. Complications include: abscesses, bleeding, graft pancreatitis (as opposed to general surgery theories, none of these cases of pancreatitis are associated with gallstones), infections, intestinal ischemia, leaks, peritonitis, pseudocysts, rejection, small bowel obstruction, other. Recipients can also develop complications (as a result of interventions) that represent exacerbations of preexisting comorbidities unrelated to the transplant graft itself. +++ COMPLICATIONS ASSOCIATED WITH ENTERIC-DRAINED PANCREATIC TRANSPLANTS ++ Leaks and intra-abdominal abscesses Usually manifested by infectious/septic findings Diagnosis is based on clinical findings in conjunction with imaging studies Treatment involves eradication of the septic focus and correction of the underlying pathology, including: Drainage of abscesses An initial period of nonsurgical treatment can be considered in instances where the infection is controlled Revision of the anastomosis Removal of the pancreas transplant (very infrequent) Monitor for the presence of infectious pseudoaneurysms (life-threatening complication that usually requires removal of the pancreatic graft and repair of the involved recipient vessels) Anastomotic bleeds Usually self-limited Correct any predisposing factors such as anticoagulation Rarely require surgical intervention +++ VASCULAR COMPLICATIONS ++ Thrombosis of ... Your Access profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'. Please click ‘Continue’ to continue the affiliation switch, otherwise click ‘Cancel’ to cancel signing in. Get Free Access Through Your Institution Learn how to see if your library subscribes to McGraw Hill Medical products. Subscribe: Institutional or Individual Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Password? Forgot Username? Sign in via OpenAthens Sign in via Shibboleth You already have access! Please proceed to your institution's subscription. Create a free a profile for additional features.