Pancreas retransplantation

Pancreas retransplantation (PRT) remains a topic of debate due to the increased risks involved and advancements in diabetes mellitus management.

The majority of PRT are pancreas after kidney (PAK) transplants, typically performed when a primary simultaneous pancreas-kidney (SPK) transplant results in pancreas graft failure while the kidney graft remains functioning. Over the past few decades, the number of PRT procedures has declined, mirroring the decrease in PAK transplant activity. Technical or late immunological loss of the initial pancreas is associated with better PRT outcomes, whereas early immunological failure and sensitization predict poor post-PRT outcome.

Several critical factors must be considered when evaluating PRT, including the cause and timing of primary pancreas graft failure, as well as the recipient's surgical and immunological profile. PRT outcomes should be interpreted with caution, as most primary pancreas transplants (PT) are SPK, whereas the majority of PRT are solitary PT. When comparing only primary solitary PT to PRT, the outcomes are similar, particularly when performed in high-volume centers.