Risk factors for postimplantation pancreatitis and pancreatic thrombosis in pancreas transplant recipients

Reperfusion pancreatitis and pancreatic thrombosis are 2 complications of pancreatic transplantation that are associated with both an increased patient morbidity and a decrease in pancreas graft survival rates. These complications are thought to be related to donor factors, procurement and preservation variables, and postimplantation recipient management. We reviewed our experience with 41 consecutive pancreas transplant patients (18 females, 23 males) performed in association with kidney transplants (n = 34), whole (n = 5) and segmental (n = 2). The average cold ischemia time (CIT) was 11.5 hr. Donor and recipient variables were related to two outcomes: (1) postoperative pancreatitis (n = 9) and (2) postoperative pancreatic thrombosis (n = 6). Steroid administration to the donor resulted in significant reduction of postimplantation pancreatitis (P < 0.001). Also, postoperative pancreatitis was significantly less common (P < 0.02) in recipients given calcium channel blockers in the early postoperative period. Pancreatic thrombosis was significantly more common in male recipients (P < 0.04) and was also significantly related to CIT (P < 0.05). These data indicate that proper donor management and pretreatment with high-dose steroids, together with shortening of CIT and postoperative administration of calcium channel blockers, are protective against pancreatic thrombosis and pancreatitis.