title: Outcome of 118 pancreas transplants with retroperitoneal portal-enteric drainage.
abstract: 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.
authors.affiliation: 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
authors.forename: U
authors.initials: U
authors.lastname: Boggi
authors.forename: F
authors.initials: F
authors.lastname: Vistoli
authors.forename: S
authors.initials: S
authors.lastname: Signori
authors.forename: M
authors.initials: M
authors.lastname: Del Chiaro
authors.forename: G
authors.initials: G
authors.lastname: Amorese
authors.forename: T
authors.initials: T
authors.lastname: Vanadia Bartolo
authors.forename: C
authors.initials: C
authors.lastname: Croce
authors.forename: F
authors.initials: F
authors.lastname: Sgambelluri
authors.forename: P
authors.initials: P
authors.lastname: Marchetti
authors.forename: F
authors.initials: F
authors.lastname: Mosca
mesh_terms: 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
chemical_list: D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents