Post-pancreatic transplant enteric leaks: The role of the salvage operation.
complication
graft survival
pancreas transplant
patient mortality
Journal
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
ISSN: 1600-6143
Titre abrégé: Am J Transplant
Pays: United States
ID NLM: 100968638
Informations de publication
Date de publication:
08 2022
08 2022
Historique:
revised:
12
05
2022
received:
11
10
2021
accepted:
12
05
2022
pubmed:
21
5
2022
medline:
5
8
2022
entrez:
20
5
2022
Statut:
ppublish
Résumé
Enteric drainage in pancreas transplantation is complicated by an enteric leak in 5%-8%, frequently necessitating pancreatectomy. Pancreatic salvage outcomes are not well studied. Risk factors for enteric leak were examined and outcomes of attempted graft salvage were compared to immediate pancreatectomy. Pancreas transplants performed between 1995 and 2018 were reviewed. Donor, recipient, and organ variables including demographics, donor type, ischemic time, kidney donor profile index, and pancreas donor risk index were analyzed. Among 1153 patients, 33 experienced enteric leaks (2.9%). Donors of allografts that developed leak were older (37.9y vs. 29.0y, p = .001), had higher KDPI (37% vs. 24%, p < .001), higher pancreas donor risk index (1.83 vs. 1.32, p < .001), and longer cold ischemic time (16.5 vs. 14.8 h, p = .03). Intra-abdominal abscess and higher blood loss decreased the chance of successful salvage. Enteric leak increased 6-month graft loss risk (HR 13.9[CI 8.5-22.9], p < .001). However, 50% (n = 12) of allografts undergoing attempted salvage survived long-term. After 6 months of pancreas graft survival, salvage and non-leak groups had similar 5-year graft survival (82.5% vs. 81.5%) and mortality (90.9% vs. 93.5%). Enteric leaks remain a challenging complication. Pancreatic allograft salvage can be attempted in suitable patients and accomplished in 50% of cases without significantly increased graft failure or mortality risk.
Identifiants
pubmed: 35593379
doi: 10.1111/ajt.17094
pii: S1600-6135(22)00026-0
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2052-2063Informations de copyright
© 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.
Références
Gruessner RW, Gruessner AC. The current state of pancreas transplantation. Nat Rev Endocrinol. 2013;9(9):555-562.
Sutherland DE, Goetz FC, Rynasiewicz JJ, et al. Segmental pancreas transplantation from living related and cadaver donors: a clinical experience. Surgery. 1981;90(2):159-169.
Dubernard JM, Traeger J, Neyra P, Touraine JL, Tranchant D, Blanc-Brunat N. A new method of preparation of segmental pancreatic grafts for transplantation: trials in dogs and in man. Surgery. 1978;84(5):633-639.
Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967;61(6):827-837.
Sutherland DE, Gruessner RW, Dunn DL, et al. Lessons learned from more than 1,000 pancreas transplants at a single institution. Ann Surg. 2001;233(4):463-501.
El-Hennawy H, Stratta RJ, Smith F. Exocrine drainage in vascularized pancreas transplantation in the new millennium. World J Transplant. 2016;6(2):255-271.
Prieto M, Sutherland DE, Goetz FC, Rosenberg ME, Najarian JS. Pancreas transplant results according to the technique of duct management: bladder versus enteric drainage. Surgery. 1987;102(4):680-691.
Sollinger HW, Cook K, Kamps D, Glass NR, Belzer FO. Clinical and experimental experience with pancreaticocystostomy for exocrine pancreatic drainage in pancreas transplantation. Transplant Proc. 1984;16(3):749-751.
Del Pizzo JJ, Jacobs SC, Bartlett ST, Sklar GN. Urological complications of bladder-drained pancreatic allografts. Br J Urol. 1998;81(4):543-547.
Monroy-Cuadros M, Salazar A, Yilmaz S, McLaughlin K. Bladder vs enteric drainage in simultaneous pancreas-kidney transplantation. Nephrol Dial Transplant. 2006;21(2):483-487.
Kandaswamy R, Skeans MA, Gustafson SK, et al. Pancreas. Am J Transplant. 2016;16(Suppl 2):47-68.
Gruessner AC, Sutherland DE. Analysis of United States (US) and non-US pancreas transplants as reported to the International Pancreas Transplant Registry (IPTR) and to the United Network for Organ Sharing (UNOS). Clin Transpl. 1998;53-73.
Gruessner AC, Gruessner RW. Pancreas transplantation of US and non-US cases from 2005 to 2014 as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR). Rev Diabet Stud. 2016;13(1):35-58.
Ferrer-Fàbrega J, Fernández-Cruz L. Exocrine drainage in pancreas transplantation: complications and management. World J Transplant. 2020;10(12):392-403.
Spetzler VN, Goldaracena N, Marquez MA, et al. Duodenal leaks after pancreas transplantation with enteric drainage - characteristics and risk factors. Transpl Int. 2015;28(6):720-728.
Manrique A, Jiménez C, López RM, et al. Relaparotomy after pancreas transplantation: causes and outcomes. Transplant Proc. 2009;41(6):2472-2474.
Singh RP, Vrakas G, Hayek S, et al. Clinically significant peripancreatic fluid collections after simultaneous pancreas-kidney transplantation. Transplantation. 2013;95(10):1263-1269.
Berger N, Wirmsberger R, Kafka R, et al. Infectious complications following 72 consecutive enteric-drained pancreas transplants. Transpl Int. 2006;19(7):549-557.
Kumar S, Singh S, Kenwar DB, et al. Management of graft duodenal leak in simultaneous pancreas kidney transplant-a case report from India and review of literature. Indian J Surg. 2016;78(5):402-406.
Boggi U, Vistoli F, Del Chiaro M, et al. Total duodenectomy with enteric duct drainage: a rescue operation for duodenal complications occurring after pancreas transplantation. Am J Transplant. 2010;10(3):692-697.
Uva PD, Villavicencio Fornaciari S, Giunippero AE, Cabrera IC, Casadei DH. Case report: pancreas graft with a duodenal complication rescued using total duodenectomy. Transplant Proc. 2014;46(9):3068-3071.
Al-Adra D, McGilvray I, Goldaracena N, et al. Preserving the pancreas graft: outcomes of surgical repair of duodenal leaks in enterically drained pancreas allografts. Transplant Direct. 2017;3(7):e179.
Stratta RJ, Sindhi R, Sudan D, Jerius JT, Radio SJ. Duodenal segment complications in vascularized pancreas transplantation. J Gastrointest Surg. 1997;1(6):534-544.
Orsenigo E, Cristallo M, Socci C, et al. Successful surgical salvage of pancreas allograft. Transplantation. 2003;75(2):233-236.
Parajuli S, Alagusundaramoorthy S, Aziz F, et al. Outcomes of pancreas transplant recipients with de novo donor-specific antibodies. Transplantation. 2019;103(2):435-440.
Parajuli S, Kaufman DB, Djamali A, et al. Association of human leukocyte antigen mismatches between donor-recipient and donor-donor in pancreas after kidney transplant recipients. Transpl Int. 2021;34(12):2803-2815.
Axelrod DA, Sung RS, Meyer KH, Wolfe RA, Kaufman DB. Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization. Am J Transplant. 2010;10(4):837-845.
Finger EB, Radosevich DM, Dunn TB, et al. A composite risk model for predicting technical failure in pancreas transplantation. Am J Transplant. 2013;13(7):1840-1849.
Ferrer-Fàbrega J, Cano-Vargas B, Ventura-Aguiar P, et al. Early intestinal complications following pancreas transplantation: lessons learned from over 300 cases - a retrospective single-center study. Transpl Int. 2021;34(1):139-152.
Pieroni E, Napoli N, Lombardo C, et al. Duodenal graft complications requiring duodenectomy after pancreas and pancreas-kidney transplantation. Am J Transplant. 2018;18(6):1388-1396.
Alhamad T, Kunjal R, Wellen J, et al. Three-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation in type 2 diabetes patients. Am J Transplant. 2020;20(3):788-796.
Siskind EJ, Amodu LI, Pinto S, et al. Bladder versus enteric drainage of exocrine secretions in pancreas transplantation: a retrospective analysis of the united network for organ sharing database. Pancreas. 2018;47(5):625-630.