Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Nath, Dilip S.; Gruessner, Angelika C.; Kandaswamy, Raja; Gruessner, Rainer W.G.; Sutherland, David E.R.; Humar, Abhinav

doi:10.1111/j.1399-0012.2005.00322.x

Cited by 56 publications

(28 citation statements)

References 8 publications

(10 reference statements)

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“…addition, late intra-peritoneal infectious complications may occur in bowel-drained transplants [91][92][93] . In more recent series, however, the incidence of and outcomes associated with surgical complications following enteric diversion are similar to those following bladder drainage and the rates of early graft loss with either technique are comparable [1][2][3]52,[62][63][64] .…”

Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

“…The incidence of surgical complications is also similar by type of transplant (SPK compared to solitary pancreas transplantation) [1][2][3] . Leaks from the allograft duodenum have been reported to occur in 5%-20% of bladder-drained and 5%-8% of bowel-drained pancreas transplants [9,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][67][68][69][70][71][72][73]80,[91][92][93][94][95] . Increasing experience with enteric exocrine drainage is likewise associated with a decreased rate of technical complications [9,38,80,[96][97][98][99][100][101][102][103] .…”

Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

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Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin (systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion (portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to recreate the natural physiology of the pancreas with firstpass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine the FIELD OF VISION

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Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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“…That can be done by an excisional biopsy of the surrounding duodenal tissue followed by primary closure. Some localized duodenal leaks can also be managed conservatively by prolonged parenteral nutrition therapy but in our setup, it was thought to be safer to resume oral nutrition early [21]. Therefore, a proximal enterostomy was done along with the tube duodenostomy as has been described, although infrequently, in management of such leaks [22].…”

Section: Discussionmentioning

confidence: 94%

“…There are reported cases of graft salvage after duodenal leaks/necrosis with total duodenectomy and drainage of pancreatic duct to bowel or bladder or occlusion of pancreatic duct with a polymer [19,24,25]. Another option described after a duodenal leak is Roux-en-Y graft duodenojejunostomy [19,21]. Graft pancreatectomy should be considered to salvage the patient in the situation of duodenal segment leaks with abdominal sepsis or prolonged morbidity with non healing leakage [26].…”

Section: Discussionmentioning

confidence: 99%

Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant—a Case Report from India and Review of Literature

et al. 2016

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Pancreatic transplantation is currently the only effective cure for Type 1 diabetes mellitus. It allows long-term glycemic control without exogenous insulin and amelioration of secondary diabetic complications. In India, pancreas transplant has not yet established with only a single successful transplant reported so far in the literature. We report a 24-year-old Type 1 diabetic patient with renal failure who underwent a simultaneous pancreas kidney transplant. On postoperative day 15, he had leak from the graft duodenal stump for which a tube duodenostomy and proximal diversion enterostomy was done. He had a high output pancreatic fistula following the procedure which was managed conservatively. The tube duodenostomy was removed at three and half months and enterostomy closure with restoration of bowel continuity was done at 6 months. After a follow up of 7 months, patient is doing well with a serum creatinine of 0.8 mg/dl and normal blood sugars, not requiring any exogenous insulin or oral hypoglycemic drugs. Managing patients with graft duodenal complications after pancreas transplant is challenging. Tube duodenostomy is a safe option in management of duodenal leak, although can lead to a persistent pancreatic fistula. A proximal diversion enterostomy allows early oral feeding and avoids the cost as well as the long term complications associated with parenteral nutrition.

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“…Common complications of pancreatic transplantation include graft thrombosis, graft pancreatitis, and rejection, but perforation of the associated duodenal graft is rare [2]. Nath et al described late anastomotic leaks with bladder drainage as not uncommon [3]. Here we report a patient who required open repair four times for perforation of the donor duodenum due to compression by an intestinal tube after simultaneous pancreas-kidney transplantation.…”

Section: Introductionmentioning

confidence: 96%

Duodenal Graft Perforation after Simultaneous Pancreas-Kidney Transplantation

Sannomiya

Nakajima

Ogawa

et al. 2017

Case Reports in Transplantation

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A 45-year-old woman with type 1 diabetes and chronic renal failure on dialysis underwent simultaneous pancreas-kidney transplantation from a brain dead donor. On postoperative day 15, acute generalized peritonitis was diagnosed and emergency laparotomy was performed. Perforation of the donor duodenum was found, which had apparently resulted from duodenal compression by the tip of the intestinal fistula tube placed for decompression. The perforation was sutured and the intestinal fistula tube was exchanged. Following this, perforation repeatedly recurred at the same site and open repair at laparotomy was required a total of four times. The fourth operation involved both suturing the perforation and covering it with ileum, after which there was no further recurrence. The patient was discharged on posttransplantation day 219, with the pancreas and kidney grafts both functioning well. This report presents a rare complication of simultaneous pancreas-kidney transplantation.

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Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors

Cited by 56 publications

References 8 publications

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Management of Graft Duodenal Leak in Simultaneous Pancreas Kidney Transplant—a Case Report from India and Review of Literature

Duodenal Graft Perforation after Simultaneous Pancreas-Kidney Transplantation

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