Duodenal leaks after pancreas transplantation with enteric drainage – characteristics and risk factors
Summary 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 p...
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| Veröffentlicht in: | Transplant international 2015-06, Vol.28 (6), p.720-728 |
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| creator | Spetzler, Vinzent N. Goldaracena, Nicolas Marquez, Max A. Singh, Sunita K. Norgate, Andrea McGilvray, Ian D. Schiff, Jeffrey Greig, Paul D. Cattral, Mark S. Selzner, Markus |
| description | Summary
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. |
| doi_str_mv | 10.1111/tri.12535 |
| format | Article |
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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.</description><identifier>ISSN: 0934-0874</identifier><identifier>EISSN: 1432-2277</identifier><identifier>DOI: 10.1111/tri.12535</identifier><identifier>PMID: 25647150</identifier><language>eng</language><publisher>England: Blackwell Publishing Ltd</publisher><subject>Adult ; Anastomotic Leak - physiopathology ; complication after transplantation ; Cytomegalovirus Infections - prevention & control ; Databases, Factual ; Diabetes Complications - surgery ; Diabetes Mellitus - surgery ; Drainage ; duodenal Leaks ; Duodenum - physiopathology ; Female ; Graft Rejection - epidemiology ; Graft Survival ; Humans ; Immunosuppression ; Kidney Transplantation - methods ; Male ; Middle Aged ; Multivariate Analysis ; pancreas after kidney transplantation ; pancreas transplantation ; Pancreas Transplantation - adverse effects ; Pancreas Transplantation - methods ; Postoperative Complications ; Reoperation ; Reperfusion Injury ; Retrospective Studies ; Risk Factors ; simultaneous pancreas–kidney transplantation ; Treatment Outcome ; Young Adult</subject><ispartof>Transplant international, 2015-06, Vol.28 (6), p.720-728</ispartof><rights>2015 Steunstichting ESOT</rights><rights>2015 Steunstichting ESOT.</rights><rights>Copyright © 2015 Steunstichting ESOT. Published by John Wiley & Sons Ltd</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4565-b0cc6773780ff89a76e712cbc9ea23a80aeb458ac4f88636021e23a09ab410f43</citedby><cites>FETCH-LOGICAL-c4565-b0cc6773780ff89a76e712cbc9ea23a80aeb458ac4f88636021e23a09ab410f43</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Ftri.12535$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Ftri.12535$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,777,781,1412,27905,27906,45555,45556</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25647150$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Spetzler, Vinzent N.</creatorcontrib><creatorcontrib>Goldaracena, Nicolas</creatorcontrib><creatorcontrib>Marquez, Max A.</creatorcontrib><creatorcontrib>Singh, Sunita K.</creatorcontrib><creatorcontrib>Norgate, Andrea</creatorcontrib><creatorcontrib>McGilvray, Ian D.</creatorcontrib><creatorcontrib>Schiff, Jeffrey</creatorcontrib><creatorcontrib>Greig, Paul D.</creatorcontrib><creatorcontrib>Cattral, Mark S.</creatorcontrib><creatorcontrib>Selzner, Markus</creatorcontrib><title>Duodenal leaks after pancreas transplantation with enteric drainage – characteristics and risk factors</title><title>Transplant international</title><addtitle>Transpl Int</addtitle><description>Summary
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.</description><subject>Adult</subject><subject>Anastomotic Leak - physiopathology</subject><subject>complication after transplantation</subject><subject>Cytomegalovirus Infections - prevention & control</subject><subject>Databases, Factual</subject><subject>Diabetes Complications - surgery</subject><subject>Diabetes Mellitus - surgery</subject><subject>Drainage</subject><subject>duodenal Leaks</subject><subject>Duodenum - physiopathology</subject><subject>Female</subject><subject>Graft Rejection - epidemiology</subject><subject>Graft Survival</subject><subject>Humans</subject><subject>Immunosuppression</subject><subject>Kidney Transplantation - methods</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Multivariate Analysis</subject><subject>pancreas after kidney transplantation</subject><subject>pancreas transplantation</subject><subject>Pancreas Transplantation - adverse effects</subject><subject>Pancreas Transplantation - methods</subject><subject>Postoperative Complications</subject><subject>Reoperation</subject><subject>Reperfusion Injury</subject><subject>Retrospective Studies</subject><subject>Risk Factors</subject><subject>simultaneous pancreas–kidney transplantation</subject><subject>Treatment Outcome</subject><subject>Young Adult</subject><issn>0934-0874</issn><issn>1432-2277</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkc1KHEEQx5ugxM0mB19AGryYw2j1d-8xaD4EIRDMeajprcm2zs5sumcQb76Db5gnSeuaHASxL91U__hRVX_G9gUci3JOxhSPhTTKvGEzoZWspHRuh81goXQF3uk99i7nKwCQ3sBbtieN1U4YmLHV2TQsqceOd4TXmWM7UuIb7EMizHxM2OdNh_2IYxx6fhPHFae-MDHwZcLY4y_if-7ueVhhwvDwkccYiqhf8vK-5m2pDim_Z7stdpk-PN1z9vPL58vTb9XF96_np58uqqCNNVUDIVjnlPPQtn6BzpITMjRhQSgVekBqtPEYdOu9VRakoFKHBTZaQKvVnB1tvZs0_J4oj_U65kBdmYGGKdeiyL0SAuB11HohrRFeFvTwGXo1TKms7ZEC670q3czZxy0V0pBzorbepLjGdFsLqB-SqktS9WNShT14Mk7Nmpb_yX_RFOBkC9zEjm5fNtWXP863yr_8iJ34</recordid><startdate>201506</startdate><enddate>201506</enddate><creator>Spetzler, Vinzent N.</creator><creator>Goldaracena, Nicolas</creator><creator>Marquez, Max A.</creator><creator>Singh, Sunita K.</creator><creator>Norgate, Andrea</creator><creator>McGilvray, Ian D.</creator><creator>Schiff, Jeffrey</creator><creator>Greig, Paul D.</creator><creator>Cattral, Mark S.</creator><creator>Selzner, Markus</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QO</scope><scope>7T5</scope><scope>8FD</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>201506</creationdate><title>Duodenal leaks after pancreas transplantation with enteric drainage – characteristics and risk factors</title><author>Spetzler, Vinzent N. ; Goldaracena, Nicolas ; Marquez, Max A. ; Singh, Sunita K. ; Norgate, Andrea ; McGilvray, Ian D. ; Schiff, Jeffrey ; Greig, Paul D. ; Cattral, Mark S. ; Selzner, Markus</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4565-b0cc6773780ff89a76e712cbc9ea23a80aeb458ac4f88636021e23a09ab410f43</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>Anastomotic Leak - physiopathology</topic><topic>complication after transplantation</topic><topic>Cytomegalovirus Infections - prevention & control</topic><topic>Databases, Factual</topic><topic>Diabetes Complications - surgery</topic><topic>Diabetes Mellitus - surgery</topic><topic>Drainage</topic><topic>duodenal Leaks</topic><topic>Duodenum - physiopathology</topic><topic>Female</topic><topic>Graft Rejection - epidemiology</topic><topic>Graft Survival</topic><topic>Humans</topic><topic>Immunosuppression</topic><topic>Kidney Transplantation - methods</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Multivariate Analysis</topic><topic>pancreas after kidney transplantation</topic><topic>pancreas transplantation</topic><topic>Pancreas Transplantation - adverse effects</topic><topic>Pancreas Transplantation - methods</topic><topic>Postoperative Complications</topic><topic>Reoperation</topic><topic>Reperfusion Injury</topic><topic>Retrospective Studies</topic><topic>Risk Factors</topic><topic>simultaneous pancreas–kidney transplantation</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Spetzler, Vinzent N.</creatorcontrib><creatorcontrib>Goldaracena, Nicolas</creatorcontrib><creatorcontrib>Marquez, Max A.</creatorcontrib><creatorcontrib>Singh, Sunita K.</creatorcontrib><creatorcontrib>Norgate, Andrea</creatorcontrib><creatorcontrib>McGilvray, Ian D.</creatorcontrib><creatorcontrib>Schiff, Jeffrey</creatorcontrib><creatorcontrib>Greig, Paul D.</creatorcontrib><creatorcontrib>Cattral, Mark S.</creatorcontrib><creatorcontrib>Selzner, Markus</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Immunology Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Transplant international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Spetzler, Vinzent N.</au><au>Goldaracena, Nicolas</au><au>Marquez, Max A.</au><au>Singh, Sunita K.</au><au>Norgate, Andrea</au><au>McGilvray, Ian D.</au><au>Schiff, Jeffrey</au><au>Greig, Paul D.</au><au>Cattral, Mark S.</au><au>Selzner, Markus</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Duodenal leaks after pancreas transplantation with enteric drainage – characteristics and risk factors</atitle><jtitle>Transplant international</jtitle><addtitle>Transpl Int</addtitle><date>2015-06</date><risdate>2015</risdate><volume>28</volume><issue>6</issue><spage>720</spage><epage>728</epage><pages>720-728</pages><issn>0934-0874</issn><eissn>1432-2277</eissn><abstract>Summary
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.</abstract><cop>England</cop><pub>Blackwell Publishing Ltd</pub><pmid>25647150</pmid><doi>10.1111/tri.12535</doi><tpages>9</tpages></addata></record> |
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| subjects | Adult Anastomotic Leak - physiopathology complication after transplantation Cytomegalovirus Infections - prevention & control Databases, Factual Diabetes Complications - surgery Diabetes Mellitus - surgery Drainage duodenal Leaks Duodenum - physiopathology Female Graft Rejection - epidemiology Graft Survival Humans Immunosuppression Kidney Transplantation - methods Male Middle Aged Multivariate Analysis pancreas after kidney transplantation pancreas transplantation Pancreas Transplantation - adverse effects Pancreas Transplantation - methods Postoperative Complications Reoperation Reperfusion Injury Retrospective Studies Risk Factors simultaneous pancreas–kidney transplantation Treatment Outcome Young Adult |
| title | Duodenal leaks after pancreas transplantation with enteric drainage – characteristics and risk factors |
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