Complications of pancreas transplantation in an initial experience of a transplant programme.

Since 1991 in our centre (Institute of General Surgery IV, University of Padova), 21 pancreas transplantations were performed; patient demographics are shown in Table 1. Of 21 pancreas transplants performed, 19 were simultaneous kidney–pancreas transplantation (SPK), one was a pancreas Introduction transplant alone (PTA) and one was a pancreas after kidney (PAK) in a patient who underwent a SPK previously and Pancreas transplantation has been demonstrated to be lost pancreas function because of rejection. In 16 patients, a successful method for treating insulin-dependent transplantation was performed with the technique described by Sollinger [3], which consists of pancreaticoduodenal transdiabetes mellitus (IDDM ) by the increasing number plantation with bladder drainage (BD) of the exocrine secreof centres using this procedure. Usually, pancreas tion. The single PTA was also performed with this technique. transplantation is combined with kidney transplantaIn five other patients, enteric drainage (ED) of exocrine tion in patients affected by IDDM and its resultant secretion was performed by a duodeno-jejunal anastomosis. end-stage nephropathy. Solitary pancreas transplant is Through a median laparotomy, a pancreatic graft was performed only in very few patients, and those selected placed into the iliac fossa with vascular end to side anastomare non-uraemic diabetic patients with extremely labile osis to the external iliac vessels. In all patients, we elongated metabolic control who, for this reason alone, experipancreatic arterial vessels (splenic and mesenteric arteries) ence a low quality of life. with interposition of a Y iliac graft. On the other side, portal vein extension with an iliac venous graft was performed only Over the last few years, pancreas transplantation in two cases. Duodenocystoor duodeno-jejunal anastomosis increased from ~500 transplants in 1990 to >1000 was performed with a circular stapler. The kidney was transplants performed in 1996. This is due to an positioned into the left iliac fossa, intraperitoneally, with increase in both patient and graft survival. In fact, vascular end to side anastomosis to external iliac vessels and from 1987–1996, 1 year patient and graft survival ureterocystoanastomosis using the Lich–Gregoir technique. worldwide are respectively ~90% and 80% [1,2]. For induction therapy, quadruple immunosuppressive Several factors account for this improvement: the use therapy with cyclosporin, azathioprine, steroids and antiof new immunosuppressive drugs, the technical lymphocyte globulin was given. In the remaining eight refinements of the transplant procedure, a more accurpatients, mycophenolate mofetil was used instead of azathioate diagnosis of rejection together with new and less toxic antiviral, antifungal and antibacterial agents Table 1. Patient demographics which are now used for prophylaxis and treatment of post-transplant infections. Nevertheless, pancreas M5F 1358 Average age 40 years (range 30–58) transplantation still presents a high incidence of surSPK/PAK/PTA 19/1/1 gical complications. Moreover, at the beginning of any Diabetic age 30 years (range 15–56) surgical experience, technical complications are more Dialytic age 2.64 years (0.5–8) frequent. Therefore, in this study, we review the surHBsAg+ 1 gical complications of pancreas transplantation in our HCV+ 2 HLA matching any match first 21 patients. Cold ischaemia time: pancreas 8.9 h (range 6–12) kidney 11.4 h (range 9–15)