Incidence, Risk Factors and Associated Clinical Outcomes of Surgical Complications Following Pancreas Transplantation

Abstract

Introduction: Pancreas transplantation is the only non-palliative method to treat type I diabetes; however, complications following this procedure have been frequent in the past, with multiple surgical refinements in technique attempted to reduce these issues. Complications have the potential to significantly decrease the post-transplantation survival rate and result in graft loss. In the past, the most frequent cause of technical failure was graft thrombosis in early post-surgery period. However, a large scale critical analysis of surgical complications in the contemporary era of pancreas transplantation is lacking. Therefore, the aim of the study was to analyze the incidence, risk factors, and associated outcomes of surgical complications following pancreas transplantation. Methods: This was a retrospective cohort study of all adult pancreas transplant recipients that underwent surgery at our institution between 2000 and 2012. Data collection included baseline characteristics and clinical outcomes, including all surgical complications, acute rejections, graft loss, and death. Surgical complications were grouped into eight categories, which included both early (within the 1 st month) and late complications. The primary outcomes of this study were to analyze the incidence, risk factors, and associated outcomes of surgical complications within these patients. Both univariate and multivariate analyses were conducted to determine the risk factors associated with surgical complications. Results: During this 12 year time period, 214 pancreas transplants were performed. Fifty-six (26%) of these cases had surgical complications. Graft thrombosis (9.8%, either partial or complete) and pancreatic leaks (7.0%) were the most common complications. Additional surgical complications are displayed in Figure 1. Table 1 displays the two groups' baseline characteristics dichotomized based on the development of a complication. of note, mean serum glucose, donor age, and acute allograft pancreatitis were all significant risk factors for the development of a surgical complication. Those that developed a surgical complication had nearly four times the risk of graft loss (43% vs. 12%, p<0.001), while death rates were similar between groups (13% vs. 11%, p=0.812). In the final model of the multivariate analysis (Table 2), only allograft pancreatitis and donor age were independent risk factors for the development of a surgical complication. Conclusions: Pancreas transplantation is a high risk surgical procedure, with a substantial risk of postoperative complications. There are clear and readily identifiable donor and recipient risk factors associated with the development of these complications, which lead to nearly four times the risk of graft loss.. (Figure Presented).