Surgical risks and outcome of pancreas retransplants

Background. The increased popularity of pancreas transplants has led to an increased number potential candidates for retransplants after the initial g raft has been lost to technical failure or rejection. We studied a group of recipients who underwent pancreas transplants at a single center to determ ine whether retransplant recipients were at higher risk of complications. Methods. Between June 1, 1994, and Dec 31, 1997, a total of 213 pancreas tr ansplants were performed at the University of Minnesota. Of these, 187 were primary transplants and 26 were retransplants. Demographically, the two gr oups were not significantly different. We analyzed and compared the two gro ups with respeect to incidence of surgical complications, graft survival ra tes, and patient survival rates. Results. Surgical complications such as bleeding and vascular thrombosis we re slightly more common after retransplants, but this trend did not quite r each statistical significance. Infectious complications and leaks were equi valent between the two groups. The incidence of acute rejection was higher after retransplants (P = .02). At 3 years postransplant, patient survival w as no different between the two 97 groups, but pancreas graft survival was lower after retransplants (P = .08). The incidence of early graft loss (by 6 months posttransplant) was significantly higher in retransplant recipient s (27% vs 14%, P = .04). Conclusions, Pancreas retransplants can be performed with a minimal increas e in surgical complications. However, graft survival after retransplants is slightly inferior to that after primary transplants, probably for both imm unologic and nonimmunologic reasons. Retransplants can be offered Co suitab le candidates, but they may require more aggressive monitoring for rejectio n.