TYPES OF PANCREAS TRANSPLANTATION
SPK : Simultaneous Pancreas - Kidney
PAK: Pancreas After Kidney
PTA: Pancreas Transplantation Alone

INDICATIONS FOR PANCREAS TRANSPLANATION
SPK - Simultaneous Pancreas Kidney tx
Terminal renal insufficiency +  type I diabetes    + complications of diabetes
Pre-terminal renal insufficiency + complications of diabetes
Bilateral nephrectomy in diabetics + complications of diabetes
 Failed kidney transplant in diabetics type I

PAK - Pancreas After Kidney tx
10 % of pancreas tx
previous kidney tx in type I diabetics     + complications of diabetes
2 groups
a. status after kidney tx
b. status after SPK with failed pancreas tx

PTA - Pancreas Transplantation Alone: 3%
1. Hypoglycemic unawareness
2. Incapacitating  clinical & emotional problems with insulin
3. Progressing diabetic complications resistent to intensive               insulin therapy
4. Early diabetic nephropathy associated with complications of diabetes
5. Resistance to SC insulin
6. After total pancreatectomy
7. Insulin allergy

CONTRA-INDICATIONS FOR PANCREAS TX
Absolute contra-indications
    Ischemic heart disease
        inoperable coronary artery disease
        cardiomyopathy with ejection fraction < 35 %
    Peripheral vascular disease
        inoperable aorto-iliac vascular disease
    Malignancy < 3 y
 Relative contra-indications
        HIV infection - hepatitis B+
        peptic ulcer
        complications of diabetes not amenable to improvement
        drug or alcohol abuse
        active infection
        recent retinal bleeding
        obesity - smoking...

RISK FACTORS IN PANCREAS TX
Age > 45 y
Obesity
Hypertension
Blindness (even monocular)
Heart disease: AMI - CABG - PTA
Peripheral vascular disease: CVA - PTA - bypass - TIA
Major amputation
Hyper coagulability
Re-transplantation..

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