title: Improvement in short-term pancreas transplant outcome by targeted antimicrobial therapy and refined donor selection.
abstract: Graft thrombosis and infectious complications are the main early causes of pancreatic allograft loss in recipients of whole vascularized pancreas transplants, resulting in loss rates up to 10 per cent in the first post transplant week. In this study we sought to determine if initiation  of a standardized selection criteria and posttransplant chemoprophylaxis regimen could reduce the rate of early allograft loss; we compared the rate of early allograft loss after introduction of these changes. Of the 61 diabetic recipients who underwent these protocols, 50.8 per cent were  female. Average age was 42.9 ± 7.4 years of age, average length of stay was 12.7 ± 8.7 days, with all transplants performed heterotopic to the right lower quadrant with venous drainage to the proximal external or common iliac vein. Organ donors were 21.4 ± 4.8 years of  age, body mass index was 23.9 ± 2.8 kg/m(2), with a length of stay of 3.7 ± 1.6 days. One-week pancreatic allograft survival for the protocolized versus nonprotocolized patients was 100 per cent versus 96.7 per cent, 1 month was 98.4 per cent versus  93.4 per cent, and 1 year was 96.7 per cent versus 88.5 per cent, respectively. In the protocolized group there were two graft losses due to infectious complications and none due to thrombosis. Before initiation of the protocols patient survival at 1 year was 91.8 per cent and after  was 100 per cent. Pancreas transplantation is arguably the most technically demanding organ transplant from a complication and loss standpoint. However, highly successful outcomes can be obtained with standardized protocols beginning pretransplant to reduce the incidence of posttransplant  complications.
authors: David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California 90095-7054, USA.
authors: Gabriel T
authors: GT
authors: Schnickel
authors: Ronald W
authors: RW
authors: Busuttil
authors: Gerald S
authors: GS
authors: Lipshutz
mesh_terms: D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002140:California / Q000453:epidemiology; D046148:Donor Selection / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000592:standards*; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult