Evolving Trends In The Management And Outcome Of Duodenal Complications After Pancreas Transplantation: A 20-year Single Institution Experience

S. Ray¹, C. Parmentier¹, G. Sapisochin¹, A. Yousuf¹, I. McGilvray¹, A. Norgate¹, M. Cattral¹, M. Selzner², T. Reichman³

¹Multiorgan transplantation, Toronto general hospital, Toronto, ON, Canada, ²University of Toronto, Toronto, ON, Canada, ³University of Toronto/The University Health Network, Toronto, ON, Canada

Meeting: 2022 American Transplant Congress

Abstract number: 9057

Keywords: Graft failure, Pancreas transplantation, Post-operative complications, Surgery

Topic: Clinical Science » Pancreas » 65 - Pancreas and Islet: All Topics

Session Information

Session Name: Pancreas and Islet: All Topics

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: Duodenal leaks have been a sinister complication in any major gastro-intestinal operation. With an incidence ranging from 4-10%, these have been one of the predominant causes of pancreas graft losses after transplantation. In this retrospective review, we aim to revisit the evolution of management strategies for duodenal leaks after pancreas transplantation from radical re-look laparotomies to minimally invasive techniques.

*Methods: Patients having undergone pancreas transplantation (Pancreas transplant alone; PTA, Simultaneous pancreas kidney; SPK and Pancreas after kidney; PAK) between January 2000 and December 2021 were included in the study. The donor and recipient peri-operative and post-operative variables were analyzed.

*Results: There were a total of 634 pancreas transplantation during the study period, majority being SPK (n=431; 68%), followed by PAK (n=177; 28%) and PTA (3.3%) and multi visceral (n=5; 0.7%). 33 (5.2%) of the grafts were retrieved from donors after cardiac death. Duodenal graft complications occurred in 12.3% (n=78), with the majority occurring in the SPK group (n=36; 46.1%) in the first year after transplantation (n=48; 61.5%). Most of the duodenal complications required laparotomy with repair +/- graft pancreatectomy (n=56; 71.7%), with 28% being managed by serial drain placements under intervention radiology guidance. Re-admission due to recurrent leak was found in 3 cases (3.8%). A trend towards more minimally invasive approach was observed in last 5 years compared to before (42% vs 23%); with a lower mortality observed in the conservative arm of management (2.5% vs 7.6%; p=0.02) and no graft loss in the former vs 10.7% (n=6) in the surgery arm. The average graft survival observed for the cohort was 6.7 years, with an average patient survival of 8.1 years.

*Conclusions: Even though early re-look surgery offers a good outcome in duodenal graft leaks after pancreas transplantation, in carefully selected cases, minimally invasive approaches in the form of percutaneous drainage has shown promising results, thereby avoiding the morbidity associated with a second look surgery and minimizing graft loss.

To cite this abstract in AMA style:

Ray S, Parmentier C, Sapisochin G, Yousuf A, McGilvray I, Norgate A, Cattral M, Selzner M, Reichman T. Evolving Trends In The Management And Outcome Of Duodenal Complications After Pancreas Transplantation: A 20-year Single Institution Experience [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/evolving-trends-in-the-management-and-outcome-of-duodenal-complications-after-pancreas-transplantation-a-20-year-single-institution-experience/. Accessed November 21, 2024.

« Back to 2022 American Transplant Congress