Pancreatic Transplantation: Evaluation and Management

Abstract

More than 2 million people in the United States have type 1 diabetes mellitus. Pancreatic transplantation has emerged as the single most effective means of achieving normal glucose homeostasis in this patient population. Newer immunosuppressive agents and surgical techniques continue to evolve, resulting in improved longterm graft and patient survival. Herein, an understanding of the evaluation, technical aspects, and perioperative management of pancreas transplantation is outlined.

Preoperative risk evaluation

“…Impairment of left ventricular function is frequent in patients with type 1 diabetes in the absence of ischemia, hypertension, or valvular heart disease (reviewed in [18]). Possible mechanisms for diabetic cardiomyopathy include abnormalities of small intramural coronary vessels, deposition of collagen, and lipid and metabolic derangements.…”

Kidney-Pancreas Transplantation

“…Every effort should be used to diagnose the treatable causes and treat them accordingly. For example for diabetic gastroparesis, use of erythromycin or domeperidone has been moderately successful (Zaman f, et al, 2004). Intractable diarrhea may be due to CMV or other microbial or protozoal infections which should be treated.…”

Transplante de pâncreas e ilhotas em portadores de diabetes melito

“…Além disso, as complicações sépticas são mais freqüentes nos casos de TSPR do que nas outras modalidades de transplante pancreático (40). As principais complicações cirúrgicas estão descritas na Tabela 2 (42).…”