Allograft Pancreatectomy: Indications and Outcomes.
This study evaluated the indications, surgical techniques, and outcomes of allograft pancreatectomy based on a single center experience. Between 2003 and 2013, 47 patients developed pancreas allograft failure, excluding mortality with a functioning pancreas allograft. Early graft loss (within 14 days) occurred in 16, and late graft loss in 31. All patients with early graft loss eventually required allograft pancreatectomy. Nineteen of 31 patients (61%) with late graft loss underwent allograft pancreatectomy. The main indication for early allograft pancreatectomy included vascular thrombosis with or without severe pancreatitis, whereas one recipient required urgent allograft pancreatectomy for gastrointestinal hemorrhage secondary to an arterioenteric fistula. In cases of late allograft pancreatectomy, graft failure with clinical symptoms such as abdominal discomfort, pain, and nausea were the main indications (13/19 [68%]), simultaneous retransplantation without clinical symptoms in 3 (16%), and vascular catastrophes including pseudoaneurysm and enteric arterial fistula in 3 (16%). Postoperative morbidity included one case each of pulmonary embolism leading to mortality, formation of pseudoaneurysm requiring placement of covered stent, and postoperative bleeding requiring relaparotomy eventually leading to femoro-femoral bypass surgery 2 years after allograftectomy. Allograft pancreatectomy can be performed safely, does not preclude subsequent retransplantation, and may be lifesaving in certain instances.
Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
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Nagai
Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
J A
JA
Powelson
Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
T E
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Taber
Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
M L
ML
Goble
Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
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Mangus
Division of Transplant Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, IN.
J A
JA
Fridell
D064591:Allografts / Q000098:blood supply*; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D016035:Pancreas Transplantation / Q000009:adverse effects*; D010180:Pancreatectomy; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013927:Thrombosis / Q000209:etiology* / Q000601:surgery*; D014184:Transplantation, Homologous
Clinical research; complication; graft survival; pancreas; practice; retransplantation; sensitization; simultaneous pancreas-kidney transplantation; surgical; technical; thrombosis and thromboembolism