BACKGROUND: We have recently described a technique for retroperitoneal pancreas transplantation (RPTx) with portal-enteric drainage (PED). Further experience with 118 RPTx is detailed herein. METHODS: Between April 2001 and August 2004, 118 patients underwent RPTx with PED among 125 recipients (94.4%) scheduled for this procedure. Surgical complications and patient and graft survivals were recorded prospectively. RESULTS: After a minimum follow-up period of 3 months (mean 27.8 +/- 13.0 months), 18 recipients (15.2%) required relaparotomy because of bleeding (n = 6; 5.1%), allograft pancreatectomy due to either hyperacute/accelerated rejection (n = 3; 2.5%) or vein thrombosis (n = 3; 2.5%), leak from duodenojejunal anastomosis (n = 2; 1.7%), bleeding and vein thrombectomy (n = 1; 0.8%), or small bowel occlusion due to bezoar (n = 1; 0.8%). One patient had a negative relaparotomy and one underwent two relaparotomies. Most patients with hemorrhage (5/7; 71.4%) were recipients of solitary pancreas grafts managed with heparin infusion. No venous thrombi extended into recipient's superior mesenteric vein. Nonocclusive venous thrombosis was diagnosed with duplex ultrasonography and confirmed at computed tomography in seven patients (5.1%). None of these patients lost graft function. Ten patients (8.5%) were diagnosed with peripancreatic fluid collections, all successfully treated by observation (n = 7) or percutaneous drainage (n = 3). Enteric bleeding occurred in eight recipients (6.8%). Overall, 1-year patient and pancreas survival rates were 97.4% and 92.0%, respectively. CONCLUSIONS: We conclude that RPTx with PED is a technical option that may be included in the repertoire of pancreas transplant surgeons.
BACKGROUND: We have recently described a technique for retroperitoneal pancreas transplantation (RPTx) with portal-enteric drainage (PED). Further experience with 118 RPTx is detailed herein. METHODS: Between April 2001 and August 2004, 118 patients underwent RPTx with PED among 125 recipients (94.4%) scheduled for this procedure. Surgical complications and patient and graft survivals were recorded prospectively. RESULTS: After a minimum follow-up period of 3 months (mean 27.8 +/- 13.0 months), 18 recipients (15.2%) required relaparotomy because of bleeding (n = 6; 5.1%), allograft pancreatectomy due to either hyperacute/accelerated rejection (n = 3; 2.5%) or vein thrombosis (n = 3; 2.5%), leak from duodenojejunal anastomosis (n = 2; 1.7%), bleeding and vein thrombectomy (n = 1; 0.8%), or small bowel occlusion due to bezoar (n = 1; 0.8%). One patient had a negative relaparotomy and one underwent two relaparotomies. Most patients with hemorrhage (5/7; 71.4%) were recipients of solitary pancreas grafts managed with heparin infusion. No venous thrombi extended into recipient's superior mesenteric vein. Nonocclusive venous thrombosis was diagnosed with duplex ultrasonography and confirmed at computed tomography in seven patients (5.1%). None of these patients lost graft function. Ten patients (8.5%) were diagnosed with peripancreatic fluid collections, all successfully treated by observation (n = 7) or percutaneous drainage (n = 3). Enteric bleeding occurred in eight recipients (6.8%). Overall, 1-year patient and pancreas survival rates were 97.4% and 92.0%, respectively. CONCLUSIONS: We conclude that RPTx with PED is a technical option that may be included in the repertoire of pancreas transplant surgeons.
Authors: Edmund Q Sanchez; Larry B Melton; Srinath Chinnakotla; Marlon F Levy; Bernard V Fischbach; Robert Goldstein; Göran B Klintmalm Journal: Proc (Bayl Univ Med Cent) Date: 2010-01
Authors: Edmund Q Sanchez; Srinath Chinnakotla; Tariq Khan; Dmitriy Nikitin; Sugam Vasani; Henry B Randall; Greg J McKenna; Richard Ruiz; Nicholas Onaca; Marlon F Levy; Robert M Goldstein; John C Docherty; David K Hurd; Göran B Klintmalm Journal: Proc (Bayl Univ Med Cent) Date: 2008-07
Authors: Andrea Proneth; Andreas A Schnitzbauer; Florian Zeman; Johanna R Foerster; Ines Holub; Helmut Arbogast; Wolf O Bechstein; Thomas Becker; Carsten Dietz; Markus Guba; Michael Heise; Sven Jonas; Stephan Kersting; Jürgen Klempnauer; Steffen Manekeller; Volker Müller; Silvio Nadalin; Björn Nashan; Andreas Pascher; Falk Rauchfuss; Michael A Ströhlein; Peter Schemmer; Peter Schenker; Stefan Thorban; Thomas Vogel; Axel O Rahmel; Richard Viebahn; Bernhard Banas; Edward K Geissler; Hans J Schlitt; Stefan A Farkas Journal: Transplant Res Date: 2013-07-01