EARLY OPERATIVE INTERVENTION FOR UROLOGIC COMPLICATIONS OF KIDNEY-PANCREAS TRANSPLANTATION

Bladder drainage of exocrine secretions during pancreas transplantatio n can be associated with significant complications. We present a proac tive approach to these complications consisting of early cystoenteric conversion (CEC). Altogether 81 patients underwent pancreas transplant between March 1985 and May 1995; 26 (32%) required CEC. Complications presented as urine leaks, other complications, and refractory metabol ic acidosis. There were 13 patients who presented with a urine Teak: 1 2 with acute abdominal pain, and 1 asymptomatic. Serum amylase and cre atinine rose a mean of 823 IU and 0.61 mg/dl, respectively. The interv al to CEC ranged from 2 to 45 months. One patient died of fungal sepsi s. Postoperative complications included duodenojejunal anastomotic ble ed (n = 1), negative relaparotomy (n = I), myocardial infarction (n = 1), graft pancreatitis (n = I), and wound infection (n = 1), Twelve pa tients presented with other complications: three women with cystitis ( n = 2) or hematuria (IL = 1), and nine men with urethritis (n = 6), sc rotal edema (n = 2), or dysuria (n = 1). The interval to conversion ra nged from 1 to 108 months. There were no deaths. One patient required relaparotomy for anastomotic bleed. One patient was converted because of refractory metabolic acidosis. Admissions and inpatient days were s ignificantly reduced. Overall mortality was 3.8%, morbidity 23.1%, and graft salvage rate 96.1%. Leak-associated mortality was 7.7%, morbidi ty 38.5%, and graft salvage rate 92.3%. For other complications the mo rtality was 0, morbidity 7.7%, and graft salvage rate 100%. CEC is a s afe, effective treatment for urologic complications of pancreas transp lantation. Morbidity and mortality were acceptable; admissions and hos pital days mere decreased. Early CEC results in superior outcomes and improved quality of life. It is preferable to nondefinitive measures f or management of urologic complications of pancreatic transplantation.