title: Duodenal leaks after pancreas transplantation with enteric drainage - characteristics and risk factors.
abstract: Pancreas-kidney transplantation with enteric drainage has become a standard treatment in diabetic patients with renal failure. Leaks of the graft duodenum (DL) remain a significant complication after transplantation. We studied incidence and predisposing factors of DLs in both simultaneous pancreas-kidney (SPK) and pancreas after kidney (PAK) transplantation. Between January 2002 and April 2013, 284 pancreas transplantations were performed including 191 SPK (67.3%) and 93 PAK (32.7%). Patient data were analyzed for occurrence of DLs, risk factors, leak etiology, and graft survival. Of 18 DLs (incidence 6.3%), 12 (67%) occurred within the first 100 days after transplantation. Six grafts (33%) were rescued by duodenal segment resection. Risk factors for a DL were PAK transplantation sequence (odds ratio 3.526, P = 0.008) and preoperative immunosuppression (odds ratio 3.328, P = 0.012). In the SPK subgroup, postoperative peak amylase as marker of preservation/reperfusion injury and recipient pretransplantation cardiovascular interventions as marker of atherosclerosis severity were associated with an increased incidence of DLs. CMV-mismatch constellations showed an increased incidence in the SPK subgroup, however without significance probability. Long-term immunosuppression in PAK transplantation is a major risk factor for DLs. Early surgical revision offers the chance of graft rescue.
authors: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Vinzent N
authors: VN
authors: Spetzler
authors: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Nicolas
authors: N
authors: Goldaracena
authors: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Max A
authors: MA
authors: Marquez
authors: Multi Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, ON, Canada.
authors: Sunita K
authors: SK
authors: Singh
authors: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Andrea
authors: A
authors: Norgate
authors: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Ian D
authors: ID
authors: McGilvray
authors: Multi Organ Transplant Program, Department of Medicine, Toronto General Hospital, Toronto, ON, Canada.
authors: Jeffrey
authors: J
authors: Schiff
authors: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Paul D
authors: PD
authors: Greig
authors: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Mark S
authors: MS
authors: Cattral
authors: Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Toronto, ON, Canada.
authors: Markus
authors: M
authors: Selzner
mesh_terms: D000328:Adult; D057868:Anastomotic Leak / Q000503:physiopathology*; D003586:Cytomegalovirus Infections / Q000517:prevention & control; D016208:Databases, Factual; D048909:Diabetes Complications / Q000601:surgery; D003920:Diabetes Mellitus / Q000601:surgery; D004322:Drainage; D004386:Duodenum / Q000503:physiopathology*; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods*; D011183:Postoperative Complications; D012086:Reoperation; D015427:Reperfusion Injury; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: complication after transplantation; duodenal Leaks; pancreas after kidney transplantation; pancreas transplantation; simultaneous pancreas-kidney transplantation