What are potential complications of Pancreas Transplant?

Pancreas transplantation is a complex surgery. This procedure carries the risk of possible complications. The main complications immediately after transplantation are surgical ones. The main ones are:

• Graft thrombosis: a blood clot develops and obstructs the renal vein (main vein in the kidney).
• Pancreatitis: Acute inflammation of the pancreas and the tissue around it.
• Duodenal leak: Perforations of the duodenum that cause the intestinal contents to exit into the abdominal cavity, producing peritonitis (inflammation of the membrane covering the abdominal organs).
• Pancreatic fistula: this occurs when fluids secreted by the pancreas drain abnormally as a result of the surgical procedure. This fistula can damage the ducts and surrounding tissues.
• Abdominal abscess: Also called an abdominal collection, this is a pocket of infected liquid and pus found within the abdominal cavity.

Rejection of the transplanted pancreas is a frequent complication, and occurs in up to 30% of transplant patients throughout the duration of the transplant. To diagnose rejection, a biopsy of the transplanted pancreas is usually performed. Depending on the type of rejection, a particular type of treatment with immunosuppressants is administered (e.g. cortisone, thymoglobulin or plasma replacement). Most rejections are usually cured with treatment.

The need to take immunosuppressive drugs to prevent rejection increases the risk of other diseases, both in the short and long term. During the initial phase of a pancreas transplant, preventive antimicrobial therapy is given to reduce this risk of infection. The main infections that can occur are:

• Viral (e.g., cytomegalovirus, herpes simplex, varicella zoster and Epstein-Barr).
• Bacterial (e.g., urinary infections, abdominal collections and bacterial pneumonia).
• Fungal (e.g., Pneumocystis jirovecii pneumonia and fungal peritonitis).

In some cases, pancreas transplant patients may develop tumours, especially after several years.

The main tumours that appear are those of the skin. For this reason, dermatological checks as well as protection from the sun are recommended. If a suspicious lesion is seen, a consultation must be arranged quickly, to assess whether it is necessary to remove it.

There are other much less common tumours, such as solid tumours (colon, gastric or lung) or haematological tumours (post-transplant lymphoproliferative disease).

For all these reasons, regular follow-ups should be maintained with a team specialising in pancreas transplantation. Despite these difficulties, the overall benefits of a pancreas transplant outweigh potential complications.