Post-pancreatic transplant enteric leaks: The role of the salvage operation

Abstract

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.

Impact of Perioperative Prophylaxis With Enterococcus Activity on Risk of Surgical-Site Infection After Pancreas Transplantation

“…Similarly, a recent analysis of PT recipients with anastomotic leak suggested a similar association with intra-abdominal infection. 23 Although this recent study found anastomotic leak to be associated with pancreas allograft failure, our study suggests that SSI also contributes to this risk. Combined, these data call for a need for strategies to prevent anastomotic leak or minimize its consequences.…”

“…Along with SSIs, anastomotic leak has been shown to be highly impactful in terms of pancreas allograft failure. 23 These 2 factors have consistently been shown to be correlated with poor pancreas allograft outcomes. 5,23 These data suggest that further efforts to prevent SSIs may lead to better allograft outcomes in this population.…”

“…In the quoted study, patients who underwent salvage operation for anastomotic leak had overall good outcomes, although intra-abdominal abscess was associated with a decreased chance of successful salvage. 23 It stands to reason that earlier intervention before abscess formation may provide the best chance for allograft salvage, for which methods for early leak identification would be needed.…”

Original pancreas transplant teohnique in terms of prevention of intra-abdominal purulent complications

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Трансплантация поджелудочной железы (ПЖ)один из сложных разделов хирургии ввиду бóльшего количества и частоты специфических осложнений в сравнении с трансплантацией других солидных органов [1][2][3][4]. Сохранение полноценно функционирующего трансплантата остается актуальной проблемой этого вида трансплантации как из-за проблем посттрансплантационного периода, связанных в основном с экзокринной секрецией и сниженной микроциркуляцией, так и хирургических осложнений, поскольку именно они часто приводят к потере трансплантата [5][6][7].По данным различных источников литературы, хирургические осложнения наблюдаются у 30-40% реципиентов поджелудочной железы, при этом в ранние сроки после операции в 5-8% случаев реципиенты теряют трансплантат по причине внутрибрюшных

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“…инфекционных осложнений, являющихся следствием несостоятельности швов дуоденального анастомоза или панкреатита трансплантата [2,4,8]. Проблема этого рода обусловлена тем, что в большинстве трансплантационных центров по-прежнему используется методика внутрибрюшного размещения трансплантата ПЖ [9][10][11][12].…”