DUODENAL COMPLICATIONS IN BLADDER-DRAINED PANCREAS TRANSPLANTATION

Background. The most common type of pancreas transplantation is whole pancreaticoduodenal (with bladder drainage) from a cadaver donor. Comp lications can arise not only from the pancreas itself but also from th e simultaneously transplanted duodenum. The purpose of this study was to analyze the incidence, diagnosis, and treatment of duodenal complic ations and their impact on patient and pancreas graft survival rates. Methods. Our retrospective study is based on 425 pancreaticoduodenal t ransplantations Performed between July 1, 1986, and June 30, 1994. Com plications pertaining to the duodenal segment were labeled early if th ey occurred within the first postoperative month and late otherwise, M ean follow-up was 55 months (range, 13 to 108 months). Results. We not ed 85 (20 %) duodenal complications: duodenal leaks (n = 42), hematuri a (n = 26), recurrent urinary tract infections (n = 9), duodenal ulcer ation or necrosis (n = 6), and bladder stones (n = 2). Of these compli cations, 40 (48 %) 1 required surgical intervention. In all, duodenal complications resulted in 14 (16 %) enteric conversions and eight (9 % ) pancreas graft losses (six because of duodenal leak and 2 because of hematuria). The mortality rate from duodenal complications was 0 %. C onclusions. Duodenal complications were common, but they were not asso ciated with a high rate of pancreas graft loss (only 9 %). With early diagnosis and treatment, morbidity can be reduced and death avoided in pancreas transplant recipients.