INCIDENCE, MANAGEMENT AND SIGNIFICANCE OF SURGICAL COMPLICATIONS AFTER PANCREATIC TRANSPLANTATION

Despite recent advances, pancreatic transplantation is still in evolut ion and is associated with considerable surgical morbidity. We reviewe d the surgical complications of 127 consecutive whole pancreatic trans plants performed at the University of Iowa between March 1984 and janu ary 1992, to evaluate the impact of these complications on graft and p atient outcome. Of these transplantations, 89 were simultaneous pancre atic and renal transplants, 32 pancreas after kidney and six pancreas alone. Of all complications requiring hospital admission, 29 percent w ere surgical in nature. Graft thrombosis (19 percent), deep wound infe ction (18 percent), duodenal leak (7 percent) and iliac artery disrupt ion (3 percent) were all associated with significant graft (n = 28) an d patient (n = 6) loss. In contrast, recurrent urinary tract infection s (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 technica lly successful transplants were associated with a 4.9 percent mortalit y rate and a 4.9 percent graft loss. The overall one year actuarial pa tient and pancreas graft survival rate was 86 and 75 percent, respecti vely. Despite ongoing refinements in surgical technique, pancreatic tr ansplantation is still associated with considerable surgical morbidity . However, the outcome is favorable if these complications are managed aggressively.