Background: Indications for allograft pancreatectomy have not been clearly established, but cause and timing of graft loss, clinical symptoms and candidacy for pancreas retransplantation are all important considerations. This study evaluated the indications, surgical techniques and outcomes of allograft pancreatectomy.

Methods: Medical records of all pancreas transplant recipients between 2003 and 2013 were retrospectively reviewed. All cases of pancreas allograft failure were reviewed if they underwent allograft pancreatectomy, whereas those who died with a functioning pancreas allograft were excluded.

Results: Forty-seven patients developed pancreas allograft failure, excluding mortality with a functioning pancreas allograft. Early graft loss (within 14 days) occurred in 16, and late graft loss in 31. All patients with early graft loss required allograft pancreatectomy which was performed between 0 and 14 days postoperatively (median 1.5 days). Pancreas retransplantation was performed in 12 of 16, and 6 underwent simultaneous allograft pancreatectomy and retransplantation. The main indication for early allograft pancreatectomy included unsalvageable pancreas graft necrosis due to vascular thrombosis with or without severe pancreatitis, whereas one required urgent allograft pancreatectomy for gastrointestinal hemorrhage secondary to an arterioenteric fistula. Nineteen of 31 (61%) with late graft loss underwent allograft pancreatectomy. In this group, median graft survival was 2.0 years and the median interval between the first pancreas transplant and allograft pancreatectomy was 2.0 years (64 days to 7.6 years). Five patients received a second pancreas transplant, and simultaneous allograft pancreatectomy and retransplant was performed in three patients. Graft failure with clinical symptoms such as abdominal discomfort, pain, and nausea were the main indications (13/19 [68%]), and vascular catastrophes including pseudoaneurysm and enteric arterial fistula, accounted for the remaining three cases (16%). Postoperative morbidity included one case each of pulmonary embolism leading to mortality, formation of pseudoaneurysm requiring placement of covered stent, intraabdominal abscess, and intraabdominal bleeding requiring relaparotomy. No significant acute kidney injuries were observed postoperatively in patients with kidney allograft.

Conclusions: Allograft pancreatectomy can be performed safely, does not preclude subsequent retransplantation and may be lifesaving in certain instances.

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