Outcome of 118 pancreas transplants with retroperitoneal portal-enteric drainage.
BACKGROUND
We have recently described a technique for retroperitoneal pancreas transplantation (RPTx) with portal-enteric drainage (PED). Further experience with 118 RPTx is detailed herein.


METHODS
Between April 2001 and August 2004, 118 patients underwent RPTx with PED among 125 recipients (94.4%) scheduled for this procedure. Surgical complications and patient and graft survivals were recorded prospectively.


RESULTS
After a minimum follow-up period of 3 months (mean 27.8 +/- 13.0 months), 18 recipients (15.2%) required relaparotomy because of bleeding (n = 6; 5.1%), allograft pancreatectomy due to either hyperacute/accelerated rejection (n = 3; 2.5%) or vein thrombosis (n = 3; 2.5%), leak from duodenojejunal anastomosis (n = 2; 1.7%), bleeding and vein thrombectomy (n = 1; 0.8%), or small bowel occlusion due to bezoar (n = 1; 0.8%). One patient had a negative relaparotomy and one underwent two relaparotomies. Most patients with hemorrhage (5/7; 71.4%) were recipients of solitary pancreas grafts managed with heparin infusion. No venous thrombi extended into recipient's superior mesenteric vein. Nonocclusive venous thrombosis was diagnosed with duplex ultrasonography and confirmed at computed tomography in seven patients (5.1%). None of these patients lost graft function. Ten patients (8.5%) were diagnosed with peripancreatic fluid collections, all successfully treated by observation (n = 7) or percutaneous drainage (n = 3). Enteric bleeding occurred in eight recipients (6.8%). Overall, 1-year patient and pancreas survival rates were 97.4% and 92.0%, respectively.


CONCLUSIONS
We conclude that RPTx with PED is a technical option that may be included in the repertoire of pancreas transplant surgeons.
Boggi
U
U
Division of Surgery in Uremic and Diabetic Patients, Department of Oncology, Transplants and Advanced Technologies in Medicine, University of Pisa, Pisa, Italy. u.boggi@med.unipi.it
Vistoli
F
F
Signori
S
S
Del Chiaro
M
M
Amorese
G
G
Vanadia Bartolo
T
T
Croce
C
C
Sgambelluri
F
F
Marchetti
P
P
Mosca
F
F
D000713:Anastomosis, Roux-en-Y; D000961:Antilymphocyte Serum / Q000627:therapeutic use; D004322:Drainage; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D009767:Obesity, Morbid / Q000601:surgery; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D011168:Portal System; D011169:Portal Vein / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D016019:Survival Analysis; D013927:Thrombosis / Q000517:prevention & control; D013997:Time Factors
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents