Introduction

Pancreas transplantation is an established treatment for insulin-dependent-diabetes-mellitus with renal failure. However, complications relating to the transplant duodenum remain a significant cause of morbidity and graft loss.

Objective

To determine the optimal management of duodenal graft complications after pancreas transplant.

Methods

A retrospective analysis of the prospective database of pancreas transplantations performed between 2000 and 2015 at the Toronto General Hospital was done to identify duodenal graft complications and management.

Results

Of a total of 426 pancreas transplants, 33 patients (7.8%) developed a duodenal graft complication. The average length of time from pancreas transplant to presentation with findings of a duodenal graft leak was 627±185 days. Duodenal leaks were managed in one of three ways. 1) Eight patients with duodenal graft leaks were initially managed with drainage alone (percutaneous or operative) once the diagnosis was made radiologically. Ultimately, seven of these eight patients required graft pancreatectomies. 2) Seventeen patients were managed with duodenal repair. This intervention was successful in 13 patients (76%), however, four patients (24%) initially managed with duodenal repair subsequently required a pancreatectomy. 3) Eight patients with duodenal leaks were managed with graft pancreatectomy at the initial operation because of worsening sepsis or surgeon discretion that the graft was non-salvageable. From 2006-2010, 45% (5/11) of patients were managed with a graft pancreatectomy and 27% (3/11) were managed with a trial of duodenal repair. In contrast, from 2011-2015, 14% (3/21) were managed with a graft pancreatectomy and 67% (15/21) were managed initially with a trial of duodenal repair.

Drainage procedures alone for duodenal leaks have a high chance of failure, and secondary graft pancreatectomy. In contrast, duodenal leaks can be successfully managed by repair, which can salvage the pancreas graft in the majority of patients. Initial management with graft pancreatectomy may be required in the setting of septic shock or patient extremis. At our institution, the trend over the last five years has been to manage duodenal graft complications with an initial attempt at repair.

CITATION INFORMATION: Al-Adra D, Laurence J, Norgate A, Goldaracena N, Marquez M, Barbas A, Dib M, Selzner M, Cattral M. Duodenal Graft Complications After Pancreas Transplant: Evolving Management. Am J Transplant. 2016;16 (suppl 3).

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