Appraising pancreatic fistula in pancreas transplantation: A comprehensive complication index based analysis of postoperative outcomes and predictors of graft survival

Autores de IIS La Fe

• Tommaso Giuliani

  Autor

• Maria José Ibáñez Juliá

  Autor

• Eva María Montalvá Orón

  Autor

• Andrea Boscà Robledo

  Autor

• Cristina Martínez Chicote

  Autor

• Ana Hernando Sanz

  Autor

• Cristina Ballester Ibáñez

  Autor

• David Calatayud Mizrahi

  Autor

• Isabel Beneyto Castello

  Autor

• Juan Francisco Merino Torres

  Autor

• Rafael López Andújar

  Autor

Grupos

• Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

• Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

Abstract

Background: A definition of pancreatic fistula specifically addressing pancreas transplantation (PT) is lacking. This study sought to characterize pancreatic fistula in this setting and to define its clinical relevance on the postoperative course and long-term graft survival (GS). Methods: Consecutive simultaneous pancreas and kidney transplantations were analysed. The global postoperative course was assessed through the comprehensive complication index (CCI). PF was defined according to the original International Study Group for Pancreatic Surgery (ISGPS) definition. Predictors of poor postoperative course and GS were explored. Results: Seventy-eight patients were analysed. Surgical morbidity was 48.7%, with severe complications occurring in 39.7%. Ninety-day mortality was 2.6%. PF occurred in 56.6% of patients, although its average clinical burden was low and did not correlate with either early or long-term outcomes. Peri-graft fluid collections, postoperative day (POD) 1 drain fluid amylase (DFA) = 2200 U/L, and POD 5 DFA/serum amylase ratio =7.0 independently correlated with poor postoperative course. Perigraft fluid collections were associated with reduced GS. Conclusion: Conventionally defined pancreatic fistula is frequent following PT, although its clinical impact is negligible. To define clinically relevant PF, novel cut-offs for DFA might be pondered in a future series, while perigraft fluid collections should be strongly considered. © 2022 IAP and EPC

Keywords

• Amylases; Drainage; Graft Survival; Humans; Pancreas Transplantation; Pancreatic Fistula; Pancreaticoduodenectomy; Postoperative Complications; Risk Factors; acetylsalicylic acid; albumin; amylase; anticoagulant agent; antifungal agent; antiinfective agent; antivirus agent; basiliximab; C peptide; cephalosporin; cotrimoxazole; hemoglobin A1c; low molecular weight heparin; mycophenolate mofetil; prednisone; sodium chloride; sultamicillin; tacrolimus; thymocyte antibody; valganciclovir; amylase; acute graft rejection; adult; Article; common iliac artery; controlled study; demographics; donor selection; drug dose reduction; drug megadose; failure to rescue (health care); false aneurysm; female; follow up; graft pancreatitis; graft survival; high frequency ultrasound; human; human tissue; immunosuppressive treatment; kidney function; major clinical study; male; observational study; pancreas fistula; pancreas transplantation; postoperative care; postoperative complication; postoperative hem