Duodenal Leaks After Pancreas Transplantation. Incidence, Management and Outcome

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Abstract

Introduction

Simultaneous pancreas-kidney transplantation (SPKT) is the therapy of choice for diabetes type 1 or 2 associated with end-stage renal disease. Graft duodenal leakage is a post-SPKT complication, reported between 5-20% in duodenal-bladder drainage, and between 5-8% in duodenal-enteric drainage, that can be associated with pancreas graft lost.

Materials and Methods

From March 1995 to April 2016, we performed 173 SPKT at our institution. We analized donor, recipient and perioperative characteristics, and the incidence of duodenal-enteric and duodenal-bladder leaks. Qualitative variables were express as mean values and SD, and qualitative variables as percentages. Differences in properties between qualitative variables were assessed by chi-square test, and comparison of quantitative variables was made by t test. Multivariate analysis using Cox regression procedure was performed to assess the effect of risk factors over the development of duodenal leaks. A p value less than 0.05 was considered statistically significant.

Results

Mean age of the recipients was 38.9+7.4 years, and mean age of the donors was 28.6+8.8 years. Recipient body mass index (BMI) was 23.6+3.7 and donor BMI was 23.7+2.9.

Results

Fifteen (8.7%) recipients developed a duodenal leaks. The incidence of duodenal leaks in duodenal-enteric drainage patients was 9% (10 cases), while in the duodenal-bladder drainage patients the incidence was 8.1% (5 cases).Nine patients underwent relaparotomy procedure to repair the duodenal leak, and the remaining 6 were managed by conservative treatment (antibiotic therapy and drainage). One patient lost the pancreas graft and the remaining 14 maintained the grafts after performing several surgical techniques (suture of duodenal defect, jejuno-jejunal Roux-en-Y exclusion, or jejunal patch over the duodenal defect). In the logistic regression analysis, the hypotension episodes that suffered the donor were the only risk factor for the development of duodenal leaks (HR: 4.1; CI 95%: 1.2-13.5; p=0.02).

Conclusion

The hypotension episodes of the donor have been related with the development of duodenal leaks in the recipient of pancreas transplant, but good results can be obtained by conservative and surgical treatment of duodenal leaks.

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