Preoperative risk evaluation: where is the limit for recipients of a pancreatic graft?

PURPOSE REVIEW: Pancreas transplantation is an accepted treatment strategy that can result in normalization of blood glucose, but this must be weighed against the risks of a surgical procedure and subsequent immunosuppression. To improve the risk/benefit ratio, pancreas transplantation is typically performed in end-stage renal disease patients who are undergoing simultaneous kidney transplantation or who previously received a renal transplant and are obligated to the use of immunosuppressive medications. As diabetic patients are at high risk for the development of cardiovascular disease, intensive evaluation before transplantation is necessary to minimize the perioperative and postoperative risk.

The field of pancreas transplantation has been limited by a lack of randomized controlled trials not only on the procedure of transplantation itself, but also on the preoperative evaluation of the patients. The data regarding pretransplant evaluation are scarce including its usefulness of tumor screening and cardiovascular evaluation, as well as its effectiveness.

Evaluation for pancreas transplantation is an important issue to minimize the risk of the patients for perioperative and postoperative complications. This is especially important in transplant recipients with a diabetic background, who are by definition 'high-risk patients' for transplantation.