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Perioperative management of the kidney–pancreas and pancreas transplant recipient 

Perioperative management of the kidney–pancreas and pancreas transplant recipient
Chapter:
Perioperative management of the kidney–pancreas and pancreas transplant recipient
Author(s):

Ugo Boggi

, George Burke

, and Kumar Belani

DOI:
10.1093/med/9780199651429.003.0015
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date: 22 October 2019

This chapter begins with an overview of the anatomy, including the exocrine and endocrine portions of the pancreas, as well as their function, their blood supply, and historical elements important in their identification. A brief history of pancreas transplantation is followed by an update on pancreas transplantation. This includes surgical options for exocrine pancreas drainage, i.e. either enteric or bladder. There is a discussion on vascular issues, i.e. options for arterial anastomosis to the pancreas transplant, as well as venous drainage, either systemic or mesenteric. This is accompanied by a description of preoperative, intraoperative, and postoperative anaesthesia issues, with emphasis on cardiac evaluation, treatment of hypertension, and intraoperative monitoring. Management of fluids and glucose control are both stressed. The intraoperative surgical management, which includes the approach to identifying hypercoagulability in the recipient, is discussed. Back-table preparation of the pancreas transplant is described. Finally, short- and long-term outcomes of pancreas transplantation are reviewed and a description of the development of recurrence of autoimmunity after pancreas transplantation, type 1diabetes recurrence, is provided.

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