Patient selection: pancreas-kidney transplant (usually for type 1 diabetes with renal failure)
Risk factors related to the donor and recipient:
(1) older donor age (possible)
(2) donor BMI > 30 kg per square meter
(3) recipient BMI > 30 kg per square meter
(4) nontraumatic death of the donor, especially after cardiac death
(5) recipient not being dialyzed prior to the transplant
(6) hypercoagulability of the recipient
(7) pretransplant panel reactive antibodies > 20%
Risk factors related to procurement and preservation:
(1) long cold ischemic time (> 12 hours)
(2) long total preservation time (> 24 hours)
Risk factors associated with transplantation technique:
(1) arterial reconstruction method other than Y-graft
(2) portoiliac venous management
(3) hypotension with vasopressor use
(4) enteric drainage (vs bladder drainage)
Risk factors associated with postoperative management:
(1) postperfusion pancreatitis
(2) intravenous tacrolimus-based regimen for immunosuppression
(3) failure to use a postoperative heparin infusion for thromboprophylaxis
