Decreased Surgical Risks of Pancreas Transplantation in the Modern Era

Abstract

ObjectiveTo document the decreased incidence of surgical complications after pancreas transplantation in recent times. Summary Background DataCompared with other abdominal transplants, pancreas transplants have historically had the highest incidence of surgical complications. However, over the past few years, the authors have noted a significant decrease in the incidence of surgical complications. MethodsThe authors studied the incidence of early (Ͻ3 months after transplant) surgical complications (e.g., relaparotomy, thrombosis, infections, leaks) after 580 pancreas transplants performed during a 12-year period. Patients were analyzed and compared in two time groups: era 1 (June 1, 1985, to April 30, 1994, n ϭ 367) and era 2 (May 1, 1994, to June 30, 1997, n ϭ 213). ResultsOverall, surgical complications were significantly reduced in era 2 compared with era 1. The relaparotomy rate decreased from 32.4% in era 1 to 18.8% in era 2. Significant risk factors for early relaparotomy were donor age older than 40 years and recipient obesity. Recipients with relaparotomy had significantly lower graft survival rates than those without relaparotomy, but patient survival rates were not significantly different. A major factor contributing to the lower relaparotomy rate in era 2 was a significant decrease in the incidence of graft thrombosis; the authors believe this lower incidence is due to the routine use of postoperative low-dose intravenous heparin and acetylsalicylic acid. The incidence of bleeding requiring relaparotomy did not differ between the two eras. Older donor age was the most significant risk factor for graft thrombosis. The incidence of intraabdominal infections significantly decreased between the two eras; this decrease may be due to improved prophylaxis regimens in the first postoperative week. ConclusionsAlthough a retrospective study has its limits, the results of this study, the largest single-center experience to date, show a significant decrease in the surgical risk associated with pancreas transplants. Reasons for this decrease are identification of donor and recipient risk factors, better prophylaxis regimens, refinements in surgical technique, and improved immunosuppressive regimens. These improved results suggest that more widespread application of pancreas transplantation is warranted.Although pancreas transplantation has gained significant popularity during the past 15 years, it has had the highest surgical complication rate of all routinely performed solid organ transplants. A significant number of pancreas grafts are lost early after transplant secondary to these surgical complications. This high graft loss rate and the morbidity associated with these surgical complications have been major factors in limiting the widespread application of pancreas transplantation. At our center, however, we have noticed a steady decrease in the incidence of these complications. Reasons for this decrease include improved donor and recipient selection criteria, refinements in surgical technique, better immunosu...

Outcomes of pancreas retransplantation in patients with pancreas graft failure

“…Complications were associated with a decline in overall graft survival from 71 per cent (22 of 31) to 38 per cent (8 of 21). This finding is consistent with a previous report39 that even recipients of a first pancreas transplantation undergoing relaparotomy following transplantation had a significantly lower graft survival rate than those without relaparotomy. Even though single pancreas transplantation is known to be associated with increased surgical risk6, the incidence of early surgical complications among the transplantation types did not differ significantly in the present study.…”

Use of Ex Vivo Normothermic Perfusion for Quality Assessment of Discarded Human Donor Pancreases

“…Furthermore, despite advances in operative technique and postoperative management, pancreas transplantation remains a high-risk procedure with a complication rate of 25-50% (3-5) and a relaparotomy rate of approximately 20% (6). Graft pancreatitis arising from ischemia reperfusion injury is a major contributing factor to many of these complications and may result in peri-pancreatic fluid collections (7), vascular thrombosis (8) and bleeding necessitating further surgery, in addition to the risk of graft loss or recipient death.…”

Improved Vascular Engraftment and Graft Function After Inhibition of the Angiostatic Factor Thrombospondin-1 in Mouse Pancreatic Islets

“…This is far more than the alleged 10 -20% of the total islet volume suggested to be enough to maintain normoglycemia in humans. Moreover, in contrast to the results for whole-organ transplantation, there seems to be a continuous decline in islet graft function, and very few patients remain insulin-independent at 5 years posttransplantation (2,3). Because the histocompatibility barrier, the underlying autoimmune disease, and the immunosuppressive agents used are the same for both transplantation procedures, it is likely that issues related to the adaptation of the implanted islets to their new microenvironment play a role for the differences in results.…”