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Pancreas transplantation would be easy if the recipients were not diabetic: A practical guide to post‐operative management of diabetic complications in pancreas transplant recipients
Author(s) -
Cerise Adam,
Chen Jeanne M.,
Powelson John A.,
Lutz Andrew J.,
Fridell Jonathan A.
Publication year - 2021
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14270
Subject(s) - medicine , pancreas transplantation , gastroparesis , diabetes mellitus , orthostatic vital signs , transplantation , intensive care medicine , pancreas , surgery , kidney transplantation , gastric emptying , blood pressure , endocrinology , stomach
Diabetes mellitus remains a major public health problem throughout the United States with over $300 billion spent in total cost of care annually. In addition to being a leading cost of kidney failure, diabetes causes a host of secondary hyperglycemic‐related complications including gastroparesis and orthostatic hypotension. While pancreas transplantation has been established as an effective treatment for diabetes, providing long‐term normoglycemia in recipients, the secondary complications of diabetes mellitus persist complicating the post‐operative course of an otherwise successful pancreas transplantation. This review describes the mechanism and impact of diabetic gastroparesis and orthostatic hypotension in the post‐operative course of pancreas transplant patients and analyzes the various treatment modalities, based on current data and extensive experience at our institution, to treat these respective complications. While gastroparesis and orthostatic hypotension remain challenging post‐operative conditions, the establishment of institutional protocols and step‐up treatment algorithms can help define more effective therapies.