Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Dec 28, 2020; 10(12): 404-414
Published online Dec 28, 2020. doi: 10.5500/wjt.v10.i12.404
Late complications of pancreas transplant
Javier Maupoey Ibáñez, Andrea Boscà Robledo, Rafael López-Andujar
Javier Maupoey Ibáñez, Andrea Boscà Robledo, Rafael López-Andujar, Hepato-Pancreatico-Biliary Surgery and Transplant Unit, La Fe University Hospital, Valencia 46026, Spain
Author contributions: Maupoey Ibáñez J performed the literature search and wrote the manuscript; Boscà Robledo A contributed to the literature search and manuscript revisions; López-Andujar R revised the manuscript; All authors read and approved the final manuscript.
Conflict-of-interest statement: The authors confirm no conflicts 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:
Corresponding author: Rafael López-Andujar, MD, PhD, Professor, Surgeon, Hepato-Pancreatico-Biliary Surgery and Transplant Unit, La Fe Universitario Hospital, C/ Fernando Abril Martorell nª 106 Planta 5 Torre F, Valencia 46026, Spain.
Received: June 22, 2020
Peer-review started: June 22, 2020
First decision: July 25, 2020
Revised: August 18, 2020
Accepted: October 9, 2020
Article in press: October 9, 2020
Published online: December 28, 2020

To summarize the long-term complications after pancreas transplantation that affect graft function, a literature search was carried out on the long-term complications of pancreatic transplantation, namely, complications from postoperative 3rd mo onwards, in terms of loss of graft function, late infection and vascular complications as pseudoaneurysms. The most relevant reviews and studies were selected to obtain the current evidence on these topics. The definition of graft failure varies among different studies, so it is difficult to evaluate, a standardized definition is of utmost importance to know the magnitude of the problem in all worldwide series. Chronic rejection is the main cause of long-term graft failure, occurring in 10% of patients. From the 3rd mo of transplantation onwards, the main risk factor for late infections is immunosuppression, and patients have opportunistic infections like: Cytomegalovirus, hepatitis B and C viruses, Epstein-Barr virus and varicella-zoster virus; opportunistic bacteria, reactivation of latent infections as tuberculosis or fungal infections. Complete preoperative studies and serological tests should be made in all recipients to avoid these infections, adding perioperative prophylactic treatments when indicated. Pseudoaneurysm are uncommon, but one of the main causes of late bleeding, which can be fatal. The treatment should be performed with radiological endovascular approaches or open surgery in case of failure. Despite all therapeutic options for the complications mentioned above, transplantectomy is a necessary option in approximately 50% of relaparotomies, especially in life-threatening complications. Late complications in pancreatic transplantation threatens long-term graft function. An exhaustive follow-up as well as a correct immunosuppression protocol are necessary for prevention.

Keywords: Pancreas transplantation, Pancreas allograft failure, Pancreas transplant rejection, Pseudoaneurysm, Allograft pancreatectomy

Core Tip: Late complications after pancreas transplant (> 3 mo after surgery) may occur, endangering loss of graft function. Chronic rejection is the main cause of long-term graft failure, occurring in 10% of patients, so targeted immunosuppressive therapy is important to prevent it; however, it predisposes to opportunistic viral, bacterial and fungal infections, and even the reactivation of latent infections, which should be prevented with perioperative prophylaxis and treated when necessary. Pseudoaneurysm should be early diagnosed, and treated by endovascular approach when possible, to prevent bleeding. Nonetheless, in some late complications, transplantectomy is a necessary option, especially in life-threatening complications.