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World J Transplant. Dec 28, 2020; 10(12): 415-421
Published online Dec 28, 2020. doi: 10.5500/wjt.v10.i12.415
Immediate post-operative complications (I): Post-operative bleeding; vascular origin: Thrombosis pancreatitis
Jose Antonio Perez Daga, Rosa Perez Rodriguez, Julio Santoyo
Jose Antonio Perez Daga, Rosa Perez Rodriguez, Julio Santoyo, Department of Surgery, Hospital Regional de Málaga, Malaga 29010, Spain
Author contributions: Perez Daga JA contributes by choosing the topic, providing expert opinion for writing our work and final editing of the manuscript; Perez Rodriguez R contributes by writing the manuscript; Santoyo J reviewed the manuscript; all authors have read and approve the final manuscript.
Conflict-of-interest statement: The authors report no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jose Antonio Perez Daga, MD, PhD, Surgeon, Department of Surgery, Hospital Regional de Málaga, Av. de Carlos Haya, 84, Malaga 29010, Spain. josea.perez.daga.sspa@juntadeandalucia.es
Received: June 23, 2020
Peer-review started: June 23, 2020
First decision: October 23, 2020
Revised: November 17, 2020
Accepted: December 17, 2020
Article in press: December 17, 2020
Published online: December 28, 2020
Processing time: 183 Days and 12.9 Hours
Abstract

Simultaneous pancreas-kidney transplantation is the treatment of choice for insulin-dependent diabetes that associates end-stage diabetic nephropathy, since it achieves not only a clear improvement in the quality of life, but also provides a long-term survival advantage over isolated kidney transplant. However, pancreas transplantation still has the highest rate of surgical complications among organ transplants. More than 70% of early graft losses are attributed to technical failures, that is, to a non-immunological cause. The so-called technical failures include graft thrombosis, bleeding, infection, pancreatitis, anastomotic leak and pancreatic fistula. Pancreatic graft thrombosis leads these technical complications as the most frequent cause of early graft loss. Currently most recipients receive postoperative anticoagulation with the aim of reducing the rate of thrombosis. Hemoperitoneum in the early postoperative period is a frequent cause of relaparotomy, but it is not usually associated with graft loss. The incidence of hemoperitoneum is clearly related to the use of anticoagulation in the postoperative period. Post-transplant pancreatitis is another cause of early postoperative complications, less frequent than the previous. In this review, we analyze the most common surgical complications that determine pancreatic graft losses.

Keywords: Pancreas transplantation; Vascular graft thrombosis; Postoperative hemorrhage; Graft pancreatitis; Reperfusion injury; Tissue donors; Risk factors

Core Tip: Pancreas transplantation still has the highest rate of surgical complications among all solid organ transplants. Pancreatic graft thrombosis leads these technical complications as the leading cause of early pancreatic graft loss. Hemoperitoneum in the early postoperative period frequently requires a relaparotomy, but usually it is not associated with graft loss. Severe pancreatitis is a major complication because it is associated with infection and can lead to graft loss.