Decreased surgical risks of pancreas transplantation in the modern era

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.