title: Clinically significant peripancreatic fluid collections after simultaneous pancreas-kidney transplantation.
abstract: BACKGROUND
  Peripancreatic fluid collections (PPFC) are a serious complication after simultaneous pancreas-kidney transplantation (SPKTx).
  
  
  METHODS
  Retrospective study for all 223 SPKTx performed from December 8, 1996, to October 10, 2011, to evaluate the risk factors (RF) and impact of PPFCs on outcomes was conducted.
  
  
  RESULTS
  Clinically significant PPFCs were seen in 36 (16%) cases, all within 3 months after transplantation. Radiologic drainage resolved 2 (6%) cases, and 34 required laparotomy (mean [SD], 4 [7]). Compared with the non-PPFC group (n=186), the PPFC group had similar patient and total kidney graft survivals but significantly lower total pancreas survival (68% vs. 85%) and greater incidence of infections (75% vs. 46%, all P<0.05) at 5 years. PPFCs were associated with early graft pancreatitis in 18 (50%), pancreatic fistula in 20 (56%, 9 with obvious duodenal stump leak) and infection in the collection in 20 (56%) cases. Comparison of PPFCs with pancreas graft loss to the PPFCs with surviving grafts showed that the incidence of pancreatic fistula was greater in the former (90% pancreas graft loss vs. 42% pancreas graft survival, P<0.01). Binary logistic regression analysis of RF for developing PPFC showed a donor age >30 years to be significant (P=0.03; odds ratio, 3.4; confidence interval, 1.1-10.5) and a trend of association with donor body mass index >30 and pancreas cold ischemia time greater than 12 hr.
  
  
  CONCLUSIONS
  PPFCs are associated with significant reduction in pancreas allograft survival and impact resource use. Donor age >30 years is a significant RF for their development. PPFCs associated with pancreatic fistula carry a greater risk for pancreas graft loss.
authors.affiliation: Department of Transplant Surgery, MRC Centre for Transplantation, Guy's Hospital, Great Maze Pond, London, United Kingdom. rpss27@yahoo.co.uk
authors.forename: Rajinder Pal
authors.initials: RP
authors.lastname: Singh
authors.forename: Georgios
authors.initials: G
authors.lastname: Vrakas
authors.forename: Samiha
authors.initials: S
authors.lastname: Hayek
authors.forename: Sara
authors.initials: S
authors.lastname: Hayek
authors.forename: Sadia
authors.initials: S
authors.lastname: Anam
authors.forename: Mariam
authors.initials: M
authors.lastname: Aqueel
authors.forename: Jonathon
authors.initials: J
authors.lastname: Olsburgh
authors.forename: Francis
authors.initials: F
authors.lastname: Calder
authors.forename: Nizam
authors.initials: N
authors.lastname: Mamode
authors.forename: Christopher
authors.initials: C
authors.lastname: Callaghan
authors.forename: Nicos
authors.initials: N
authors.lastname: Kessaris
authors.forename: James
authors.initials: J
authors.lastname: Pattison
authors.forename: Rachel
authors.initials: R
authors.lastname: Hilton
authors.forename: Geoff
authors.initials: G
authors.lastname: Koffman
authors.forename: John D
authors.initials: JD
authors.lastname: Taylor
authors.forename: Martin W
authors.initials: MW
authors.lastname: Drage
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006084:Graft Rejection; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010185:Pancreatic Fistula / Q000209:etiology; D010195:Pancreatitis / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors