Incidence, management and significance of surgical complications after pancreatic transplantation.

Despite recent advances, pancreatic transplantation is still in evolution and is associated with considerable surgical morbidity. We reviewed the surgical complications of 127 consecutive whole pancreatic transplants performed at the University of Iowa between March 1984 and January 1992, to evaluate the impact of these complications on graft and patient outcome. Of these transplantations, 89 were simultaneous pancreatic and renal transplants, 32 pancreas after kidney and six pancreas alone. Of all complications requiring hospital admission, 29 percent were surgical in nature. Graft thrombosis (19 percent), deep wound infection (18 percent), duodenal leak (7 percent) and iliac artery disruption (3 percent) were all associated with significant graft (n = 28) and patient (n = 6) loss. In contrast, recurrent urinary tract infections (20 percent), recurrent pancreatitis (17 percent), superficial wound infections (13 percent) and recurrent hematuria (12 percent) did not affect patient or graft outcome. Surgical complications after technically successful transplants were associated with a 4.9 percent mortality rate and a 4.9 percent graft loss. The overall one year actuarial patient and pancreas graft survival rate was 86 and 75 percent, respectively. Despite ongoing refinements in surgical technique, pancreatic transplantation is still associated with considerable surgical morbidity. However, the outcome is favorable if these complications are managed aggressively.