The use of low dose octreotide prophylaxis in pancreatic transplants with enteric drainage. Results of a prospective randomized single center trial.
OBJECTIVE
The aim of this study was to investigate the effect of octreotide in the perioperative course of pancreas transplants drained into the bowel in terms of fistula formation, pancreatitis, hemorrhage and thrombosis, and to compare the results to patients not receiving octreotide in a prospectively, randomized single center trial.


METHODS
Forty pancreas transplant recipients were prospectively randomized to either receive or not to receive octreotide 0.1 mg subcutaneously at the time of operation and 3x/d there after until post-operative day 7. The incidence of pancreatic leakage from the anastomosis and the content of peritoneal fluid drainage regarding amylase and lipase concentrations collected by abdominal drains were registered on day 0-10. Both groups were comparable for age, sex, onset of diabetes, surgical procedure and immunosuppressive regimen.


RESULTS
There were 35 simultaneous pancreas-kidney transplants and five solitary pancreas transplants, two in the octreotide and three in the control group two pancreas after kidney, one pancreas after liver pancreas, one pancreas after simultaneous pancreas kidney transplantation, one pancreas transplant alone. All had enteric drainage. Twenty patients received octreotide and 20 did not. In one patient, receiving octreotide the pancreas had to be removed for septic complications because of an enteric fistula arising from the anastomosis (1/20 = 5%). The incidence in patients on octreotide vs. non-octreotide was 1 vs. 0 for pancreatitis, 2 vs. 3 for hemorrhage, 2 vs. 1 for thrombosis and 2 vs. 0 for pancreatic fistulae resulting in an actual overall 12 months patient survival of 100% in both groups and a pancreas survival of 85% vs. 95%. For primary simulaneous pancreas kidney the pancreas graft survival was 93%. The amylase and lipase concentrations of fluid collections drained into the peritoneum on day 0 to 10 post-operatively indicating pancreatic fistulization was comparable in both groups.


CONCLUSIONS
The use of octreotide following pancreas transplantation did not prevent pancreatic fistula formation from the anastomosis neither from the pancreatic capsule in pancreas transplantation with enteric drainage. Further studies are required to finally evaluate the benefit of this prophylactic treatment.
Hesse
Uwe J
UJ
Department of Surgery, Ghent University Hospital, De Pintelaan, Ghent, Belgium. uwe.hesse@ugent.be
Meester
Daan
D
Troisi
Roberto
R
Cathenis
Koen
K
Lameire
Norbert
N
Hemptinne
Bernard
B
D000328:Adult; D000681:Amylases / Q000032:analysis; D000714:Anastomosis, Surgical / Q000009:adverse effects; D018890:Chemoprevention; D004305:Dose-Response Relationship, Drug; D004322:Drainage; D005260:Female; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006470:Hemorrhage / Q000517:prevention & control; D006801:Humans; D008049:Lipase / Q000032:analysis; D008297:Male; D008875:Middle Aged; D015282:Octreotide / Q000627:therapeutic use*; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010182:Pancreatic Diseases / Q000517:prevention & control; D010185:Pancreatic Fistula / Q000209:etiology / Q000517:prevention & control*; D010189:Pancreatic Juice / Q000737:chemistry; D010195:Pancreatitis / Q000517:prevention & control; D011446:Prospective Studies; D016037:Single-Blind Method; D013927:Thrombosis / Q000517:prevention & control
D005765:Gastrointestinal Agents; D008049:Lipase; D000681:Amylases; D015282:Octreotide