Outcome of 118 Pancreas Transplants With Retroperitoneal Portal-Enteric Drainage

• Published in: Transplantation proceedings Vol. 37; no. 6; pp. 2648 - 2650
• Main Authors: Boggi, U., Vistoli, F., Signori, S., Del Chiaro, M., Amorese, G., Vanadia Bartolo, T., Croce, C., Sgambelluri, F., Marchetti, P., Mosca, F.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2005; Elsevier Science
• Subjects: Anastomosis, Roux-en-Y; Antilymphocyte Serum - therapeutic use; Biological and medical sciences; Drainage; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival; Humans; Immunosuppressive Agents - therapeutic use; Medical sciences; Obesity, Morbid - surgery; Pancreas Transplantation - adverse effects; Pancreas Transplantation - mortality; Pancreas Transplantation - physiology; Portal System; Portal Vein - surgery; Postoperative Complications - epidemiology; Retroperitoneal Space; Retrospective Studies; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Analysis; Thrombosis - prevention & control; Time Factors; Tissue, organ and graft immunology; Graft(material); Prognosis; Retroperitoneal; Transplantation; Homotransplantation; Drainage; Medicine; Treatment; Bypass; Surgery; Evolution; Graft; Portal vein; Pancreas
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.06.081

We have recently described a technique for retroperitoneal pancreas transplantation (RPTx) with portal-enteric drainage (PED). Further experience with 118 RPTx is detailed herein. Between April 2001 and August 2004, 118 patients underwent RPTx with PED among 125 recipients (94.4%) scheduled for this procedure. Surgical complications and patient and graft survivals were recorded prospectively. After a minimum follow-up period of 3 months (mean 27.8 ± 13.0 months), 18 recipients (15.2%) required relaparotomy because of bleeding ( n = 6; 5.1%), allograft pancreatectomy due to either hyperacute/accelerated rejection ( n = 3; 2.5%) or vein thrombosis ( n = 3; 2.5%), leak from duodenojejunal anastomosis ( n = 2; 1.7%), bleeding and vein thrombectomy ( n = 1; 0.8%), or small bowel occlusion due to bezoar ( n = 1; 0.8%). One patient had a negative relaparotomy and one underwent two relaparotomies. Most patients with hemorrhage (5/7; 71.4%) were recipients of solitary pancreas grafts managed with heparin infusion. No venous thrombi extended into recipient’s superior mesenteric vein. Nonocclusive venous thrombosis was diagnosed with duplex ultrasonography and confirmed at computed tomography in seven patients (5.1%). None of these patients lost graft function. Ten patients (8.5%) were diagnosed with peripancreatic fluid collections, all successfully treated by observation ( n = 7) or percutaneous drainage ( n = 3). Enteric bleeding occurred in eight recipients (6.8%). Overall, 1-year patient and pancreas survival rates were 97.4% and 92.0%, respectively. We conclude that RPTx with PED is a technical option that may be included in the repertoire of pancreas transplant surgeons.