M. Barrett1, Y. Lu2, D. M. Cibrik2, R. S. Sung1, K. J. Woodside1 1University Of Michigan,General Surgery,Ann Arbor, MI, USA 2University Of Michigan,Internal Medicine,Ann Arbor, MI, USA
Introduction: Despite improvements in pancreas transplant outcomes, a small but significant subset of patients experience catastrophic graft failure, often due to allograft thrombosis, necessitating transplant pancreatectomy. It is unclear how this subset of patients fares when retransplanted. We sought to review our institution’s experience with second pancreas transplant after previous transplant pancreatectomy.
Methods: Patient encounters in which transplant pancreatectomies were performed were identified using associated billing codes. Chart review of these encounters through both the Organ Transplant Information System and the hospital EMR system was used to collect demographic and outcomes data. Further investigation of discharge paperwork, clinic notes, and outside records was performed on patients who underwent second pancreas transplant to analyze allograft function.
Results: Between January 1990 and July 2016, 402 pancreas transplants—293 simultaneous kidney pancreas (KP) transplants, 99 pancreas after kidney (PAK) transplants, and 10 pancreas transplants alone (PTA). Amongst this cohort, 87 pancreatectomies were performed in 78 patients. Of these, 15 (19%) patients underwent a second pancreas transplant after transplant pancreatectomy. The study population consisted of 5 women and 10 men. Median age at initial pancreas transplant was 37 years (range 27 – 57 years), with 8 patients who initially underwent PAK transplant, 6 who underwent a simultaneous KP transplant and 1 who underwent PTA. Indication for initial pancreatectomy was thrombosis in 12 patients, all of whom had their graft removed within one month of transplant (median 1 day, range 0 – 31 days). Another 3 patients developed an intraabdominal infection requiring pancreas allograft explantation (median 26 months, range 6 – 108 months).
Median time from pancreatectomy to second transplant was 18 months (range 7-94 months). For the second pancreas transplants, one patient underwent KP transplant, while all others underwent pancreas-only transplant. Median time after second transplant to last documented follow was 10 years (36 days – 19 years). Four pancreas allografts are still functioning—3 of which have been functional for 10 years. Of the remaining patients, 7 required transplant pancreatectomy for allograft thrombosis in the immediate post operative period (4 at 1 day, with the rest within a week). Four others failed after the perioperative period (at 1, 2, 2, and 6 years, respectively). The 8 patients with graft function for a year or more were younger at second transplant (median 38 vs. 45 years old), although this was not statistically significant.
Conclusion: Pancreas retransplant after previous transplant pancreatectomy is feasible, although it is associated with a high initial failure rate, suggesting that these patients require additional considerations before retransplantation—over and above that of those with intact failed pancreas allografts.