Technical failures after pancreas transplants: why grafts fail and the risk factors--a multivariate analysis.
BACKGROUND
Technical failure (TF) rates remain high after pancreas transplants; while rates have decreased over the last decade, more than 10% of all pancreas grafts continue to be lost due to technical reasons. We performed a multivariate analysis to determine causes and risk factors for TF of pancreas grafts.


RESULTS
Between 1994 and 2003, 937 pancreas transplants were performed at our center in the following transplant categories: simultaneous pancreas-kidney (SPK) (n=327), pancreas after kidney (PAK) (n=399), and pancreas transplant alone (PTA) (n=211). Of these, 123 (13.1%) grafts were lost due to technical reasons (thrombosis, leaks, infections). TF rates were higher for SPK (15.3%) versus PAK (12.2%) or PTA (11.4%), though this was not statistically significant. Thrombosis accounted for 52.0% of all TFs. Other causes were infections (18.7%), pancreatitis (20.3%), leaks (6.5%), and bleeding (2.4%). Thrombosis was the most common cause for TF in all three transplant categories. By multivariate analysis, the following were significant risk factors for TF of the graft: recipient body mass index (BMI) >30 kg/m (relative risk [RR]=2.42, P=0.0003), preservation time >24 hr (1.87, P=0.04), cause of donor death other than trauma (RR=1.58, P=0.04), enteric versus bladder drainage (1.68, P=0.06), and donor BMI >30 kg/m (1.66, P=0.06). Not significant were donor or recipient age, a retransplant, and the category of transplant.


CONCLUSIONS
TFs remain significant after pancreas transplants. In SPK recipients, TF represents the most common cause of pancreas graft loss. For isolated pancreas transplants, TF is second only to rejection as a cause of graft loss. Increased preservation times and donor or recipient obesity seem to be risk factors. Minimizing these risks factors would be important to try to decrease TF.
Humar
Abhinav
A
Department of Surgery, University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA. humar001@umn.edu
Ramcharan
Thigarajan
T
Kandaswamy
Raja
R
Gruessner
Rainer W G
RW
Gruessner
Angelika C
AC
Sutherland
David E R
DE
D000328:Adult; D015992:Body Mass Index; D002423:Cause of Death; D006084:Graft Rejection / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation; D008875:Middle Aged; D015999:Multivariate Analysis; D009926:Organ Preservation / Q000009:adverse effects; D016035:Pancreas Transplantation / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors; D017211:Treatment Failure