Experience with ATG short course high dose induction therapy in a series of 112 enteric drained pancreatic transplants.
BACKGROUND
New immunosuppressive protocols and advanced surgical technique resulted in a major improvement in the outcome of pancreatic transplantation.


METHODS
112 enteric drained whole pancreas transplants (PTx) performed at the Innsbruck University Hospital between 3.1997 and 10.2001 were retrospectively analysed. Prophylactic immunosuppression consisted of FK506, MMF and steroids. A short course of high dose ATG induction was given additionally. Perioperative antimicrobial prophylaxis consisted of Amoxicillin/Clavulanic (32 PTx), Pipercillin/Tazobactam (68 PTx), quinolones (10 PTx) or macrolide (2 PTx). 64 patients additionally received fluconazole.


RESULTS
Actuarial patient, pancreas and kidney graft survival at one year were 96.4%, 86.7% and 95.3%, surgical complication rate was 28%, rejection rate 40%. Eight grafts were lost due to intraabdominal infection, seven due to rejection. Median perioperative observation days (OD) were 29 (range 14-125), patients were on antibiotics for 68% of OD, and developed fever on 33% of OD. Incidence of CMV infection was 42% (but only five patients developed CMV disease), HSV 24%, intraabdominal infection 22%, UTI 11%, wound infection 9% and pneumonia: 5%.


CONCLUSIONS
ATG short course induction is well tolerated after enteric drained PTx. Infection represents a frequent and at least for IA sepsis serious complication after PTx with enteric drainage.
Bonatti
H
H
Department of General Surgery, Innsbruck University Hospital, Austria. Hugo.Bonatti@dr.com
Berger
N
N
Kafka
R
R
Tabbi
M G
MG
Königsrainer
A
A
Margreiter
R
R
Steurer
W
W
D000328:Adult; D000961:Antilymphocyte Serum / Q000627:therapeutic use*; D001424:Bacterial Infections / Q000517:prevention & control; D001831:Body Temperature; D002097:C-Reactive Protein / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D004322:Drainage / Q000379:methods; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology; D008875:Middle Aged; D009181:Mycoses / Q000517:prevention & control; D016035:Pancreas Transplantation / Q000276:immunology* / Q000379:methods* / Q000401:mortality; D010976:Platelet Count; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D002097:C-Reactive Protein