Relaparotomy after pancreas transplantation: causes and outcomes.
BACKGROUND
Surgical complications after pancreas transplantation, and subsequently relaparotomies, are frequently associated with graft loss, important morbidities, and occasionally patient death.


METHODS
From March 1995 to September 2008, 118 diabetic patients underwent pancreas transplantation: 109 simultaneous pancreas-kidney and nine pancreas after kidney. There were 68 men and 50 women. Mean age at transplantation was 37.8 +/- 7.8 years (range = 25-66). We analyzed donor and recipient characteristics, rate of relaparotomies, risk factors, as well as patient and graft survivals.


RESULTS
Forty patients (33.9%) underwent one or more relaparotomies. The causes for relaparotomy were: graft thrombosis in 15 patients (12.7%), bleeding in 14 (11.9%), duodenal stump leak in 7 (5.9%), severe pancreatitis and/or abscess in 5 (4.2%), and small bowel obstruction in 3 (2.5%). Graft pancreatectomy was performed in 52.5% (21 patients). The causes of graft loss were: graft thrombosis in 15 patients (12.7%), bleeding in 14 (11.9%), and duodenal stump leaks in 7 (5.9%). Mortality rate after relaparotomy was 3.38% (four patients). Relaparotomy rate for thrombosis was higher among the portoiliac than the portocaval vein anastomosis group (20.0% vs 10.2%; P = NS), and significantly higher for the bladder drainage than the enteric drainage technique (18.2% vs 5.8%; P < .05). Patients without relaparotomy experienced a significantly higher 5-year graft survival rate than those who underwent relaparotomy (87.2% vs 37.9%; P < .001), but 5-year patient survivals were similar (96.8% without relaparotomy vs 89.6% with relaparotomy).


CONCLUSIONS
Abdominal complications and the necessity for relaparotomy were associated with important morbidity and significantly reduced pancreas graft survival.
Manrique
A
A
Servicio de Cirugía General, Aparato Digestivo y Trasplante de Organos Abdominales, Hospital Doce de Octubre, Madrid, Spain.
Jiménez
C
C
López
R M
RM
Cambra
F
F
Morales
J M
JM
Andrés
A
A
Gutiérrez
E
E
Ortuño
T
T
Calvo
J
J
Sesma
A G
AG
Moreno
E
E
D000038:Abscess / Q000401:mortality; D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D004386:Duodenum / Q000473:pathology; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data; D007813:Laparotomy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000401:mortality / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000145:classification / Q000453:epidemiology / Q000401:mortality; D012086:Reoperation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D015996:Survival Rate