Complications

Complications

Major abdominal surgery carries a number of general risks which are well detailed elsewhere; for the sake of brevity , they will not be discussed here. Pancreas transplant patients are Frederic Eugene Basil Foley , 1891–1966, urologist, Ancker Hospital, St Paul, MN, USA. and to ensure that they are suitable for major surgery . Despite this, longstanding diabetes means that complications are common and potentially serious. Intraoperative complications suc h as bleeding following reperfusion can lead to the need for blood transfusion and inotropic support. Up to one in three patients require further surgery postoperatively . This may be due to reperfusion pancreatitis or bleeding. Reperfusion pancreatitis (a manifestation of ischaemia–reperfusion-related injury) can result in an amylase-rich transudate around the pancreas and in the abdominal cavity . Drainage may be neces - sary to aid recovery: in patients with an ongoing inflammatory state clinicians have a low threshold to return to the operating theatre for washout and debridement of peripancrea tic necro - sis. Thrombosis a ff ects up to 8% of patients and this may result in early graft loss or β -cell dysfunction. Anastomotic leaks, particularly from the duodenum, are rare but di ffi cult to manage; they can be controlled with direct drainage, suc h as - a Foley catheter within the duodenum. However, such compli - cations may necessitate surgical revision or, in extreme cases, graft pancreatectomy . Bladder-drained pancreases can cause cystitis from pan - creatic enzyme secretion and electrolyte disturbance, acidosis - and dehydration fr om the loss of bicarbonate. Up to 50% of patients with bladder-drained pancreas transplants require enteric conversion (wher e the transplant duodenum is surgically - detached from the bladder and reconnected to the small bowel) within the first year following transplant. This usually follows recurrent hospital admissions for acidosis and is performed to mitigate the risk of acute kidney injury . Also, the indication for conversion may be driven by patient choice because of symp - toms from chemical cystitis, urinary tract infection (UTI) and the need for high-dose oral sodium bicarbonate. Late compli - cations of pancreas transplantation include pseudoaneurysm formation, w hich may result from fungal infection or a vascular anastomosis, and highlights the importance of culturing the preservation fluid at the time of transplant and tr eating any cultured microorganisms. A full list of complications following pancreas transplanta - tion is given in Table 90.1