Background: Patient and graft survival following pancreas transplantation have significantly improved, but this procedure still requires a major complex surgery with the potential for significant postoperative morbidity. The aim of this study was to use the data from a single large volume pancreas transplant center to describe the potential postoperative complications requiring return to surgery at any point following pancreas transplantation.

Methods: The Pancreas Transplant Database and EMR were queried for patients who underwent pancreas transplantation between July 2003 to January 2023 either in combination with a kidney transplant (SPK), following a kidney transplant (PAK), or alone (PTA). We included other combinations of organs with a pancreas if the allografts were implanted separately. All pancreas transplants were performed with systemic venous and enteric exocrine drainage with ipsilateral placement of both organs for SPK. Immunosuppression included rATG induction, steroid avoidance, tacrolimus and sirolimus maintenance with addition of mycophenolic acid for PTA. All recipients that returned to surgery at any point after pancreas transplant were analyzed.

Results: The final study population consisted of 706 patients. 406 (57.5%) SPK, 287 (40.7%) isolated pancreas transplantation (PAK or PTA), 10 (1.4%) liver-pancreas transplantation and 3 (0.4%) lung-pancreas transplantation. The mean age was 44 years (SD 10.1/ Minimum 13-Maximum 75). 201 (28.5%) patients required some type of surgical intervention after pancreas transplant. 17 (2.4%) underwent allograft pancreatectomy and 4 (0.6%) allograft nephrectomy. 5 (0.7%) patients underwent exploratory laparotomy for bleeding, 3 (0.4%) for graft thrombectomy, 17(2.4%) for bowel resection, 13 (1.8%) for adhesiolysis and 61 (8.6%) for hernia repair. An additional 55 (7.8%) patients underwent negative exploratory laparotomy for clinical picture or laboratory indications of possible allograft thrombosis. (Table)

Conclusion: Pancreas transplantation has significantly improved over the last decades in terms of surgical techniques, graft survival and patient survival. However, the rate of postoperative complications is still high and complications requiring surgical re-intervention remains high