Intra-abdominal Infections in Pancreas Transplant Recipients

Abstract

During a 7-year period, 116 pancreas transplants were performed in 98 diabetic patients (49 with and 49 without previous kidney transplants) at the University of Minnesota. The posttransplant clinical course of 26 recipients (22%) was complicated by an intra-abdominal infection (8 with and 18 without previous kidney transplants). Infections occurred in 19/57 cases (33%) in which exocrine secretions were managed by enteric drainage, in 5/15 cases (33%) managed by free drainage into the peritoneal cavity, in 1/39 cases (3%) in which the duct was injected with a synthetic polymer, and in 1/2 cases (50%) in which a pancreaticocystostomy was performed. The organisms Escherichia coli, enterococci, bacteroides, and several anaerobes were cultured from the patients with enteric drainage, while staphylococci were associated with the open duct drainage. Fungal infections with Candida were found with all techniques. Surgical and percutaneous drainage was performed in all patients. In 14 patients, functioning and, in four patients, nonfunctioning grafts were removed. In five patients, the infection resolved while the grafts were functioning, and these patients are currently alive and well. Seven of the 26 patients with infections died (27% mortality rate), five after graft removal and two with the graft still in place (1 with and 1 without function), five in the open-duct, and one each in the enteric and urinary drainage categories. In the 90 cases without intra-abdominal infection, only six patients died (4 cardiovascular, 1 anaphylaxis, 1 cytomegalovirus infection), for a mortality rate of 7%.

Value of donor swabs for intra-abdominal infection in simultaneous pancreas-kidney transplantation

“…There are studies showing a significantly higher rate of abdominal infections for enteric-drained versus bladder-drained transplants (4,14). We did not find any statistically significant differences in the incidence of abdominal infections comparing the techniques of exocrine drainage of the pancreas graft.…”

“…The rate of intra-abdominal infection has been described by other groups to be 12% to 27.5% (4,(12)(13)(14)(15). These studies report on other sample sizes ranging from 33 to 199 consecutive patients and thus reflect diverging experience with handling complications (4,12,15).…”

Evolution in Pancreas Transplantation Techniques: Simultaneous Kidney-Pancreas Transplantation Using Portal-Enteric Drainage Without Antilymphocyte Induction

“…21 With either systemic-bladder or systemic-enteric drainage, the reported incidence of intraabdominal infection ranges from 13% to 33%. 20,21,[45][46][47][48][49][50] In the present series, we noted two cases (7%) of intraabdominal infection, both resulting in relaparotomy. We believe that Roux limb diversion may confer protection of the enteric anastomosis, and the absence of exposure to antilymphocyte agents may result in a reduced risk of infection.…”

Characterization and Impact of Wound Infection After Pancreas Transplantation

“…'1 The reported incidence of wound in¬ fection after pancreas transplantation ranges from 7% to 50%.2'4"10 Superficial and deep (ie, intra-abdominal) wound infec¬ tions occur alone or in combination, and often these represent serious complica¬ tions that may lead to allograft loss and that are associated with patient death. 6,8,11 The attendant morbidity associated with the oc¬ currence of wound infection may be, in part, a result of delayed diagnosis owing to the suppression of signs and symp¬ toms of infections that accompanies immunosuppression. '1 However, the pathogenetic factors that predispose patients to these types of infection, the source of the microbial inoculum, and the optimal See Patients and Methods on next page PATIENTS AND METHODS STUDY POPULATION From January 1, 19901, , to September 30, 1993 pa¬ tients underwent 207 consecutive whole-organ pancreas transplantation procedures at the University of Minne¬ sota.…”