Objective
To document the decreased incidence of surgical complications after pancrea
s transplantation in recent times.
Summary Background Data
Compared with other abdominal transplants, pancreas transplants have histor
ically had the highest incidence of surgical complications. However, over t
he past few years, the authors have noted a significant decrease in the inc
idence of surgical complications.
Methods
The authors studied the incidence of early (<3 months after transplant) sur
gical complications (e.g., relaparotomy, thrombosis, infections, leaks) aft
er 580 pancreas transplants per formed during a 12-year period. Patients we
re analyzed and compared in two time groups: era 1 (June 1, 1985, to April
30, 1994, n = 367) and era 2 (May i, 1994, to June 30, 1997, n = 213).
Results
Overall, surgical complications were significantly reduced in era 2 compare
d with era 1. The relaparotomy rate decreased from 32.4% in era 1 to 18.8%
in era 2. Significant risk factors for early relaparotomy were donor age ol
der than 40 years and recipient obesity, Recipients with relaparotomy had s
ignificantly lower graft survival rates than those without relaparotomy, bu
t patient survival rates were not significantly different. A major factor c
ontributing to the lower relaparotomy rate in era 2 was a significant decre
ase in the incidence of graft thrombosis; the authors believe this lower in
cidence is due to the routine use of postoperative low-dose intravenous hep
arin and acetylsalicylic acid. The incidence of bleeding requiring relaparo
tomy did not differ between the two eras. Older donor age was the most sign
ificant risk factor for graft thrombosis. The incidence of intraabdominal i
nfections significantly decreased between the two eras; this decrease may b
e due to improved prophylaxis regimens in the first postoperative week.
Conclusions
Although a retrospective study has its limits, the results of this study, t
he largest single-center experience to date, show a significant decrease in
the surgical risk associated with pancreas transplants. Reasons for this d
ecrease are identification of donor and recipient risk factors, better prop
hylaxis regimens, refinements in surgical technique, and improved immunosup
pressive regimens. These improved results suggest that more widespread appl
ication of pancreas transplantation is warranted.