Duodenal graft complications requiring duodenectomy after pancreas and pancreas–kidney transplantation |
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| Authors: | Erica Pieroni Niccolò Napoli Carlo Lombardo Piero Marchetti Margherita Occhipinti Carla Cappelli Davide Caramella Giovanni Consani Gabriella Amorese Maurizio De Maria Fabio Vistoli Ugo Boggi |
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| Affiliation: | 1. Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy;2. Division of Metabolism and Cell Transplantation, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy;3. Division of Radiology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy;4. Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy;5. Division of Urology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy |
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| Abstract: | Duodenal graft complications are poorly reported complications of pancreas transplantation that can result in graft loss. Excluding patients with early graft failure, after a median follow‐up period of 126 months (range 23‐198) duodenectomy was required in 14 of 312 pancreas transplants (4.5%). All patients were insulin‐independent at the time of diagnosis. Reasons for duodenectomy included delayed duodenal graft perforation (n = 10, 71.5%) and refractory duodenal graft bleeding (n = 4, 28.5%). In patients with duodenal graft bleeding, a total duodenectomy was performed. In patients with duodenal graft perforation, preservation of a duodenal segment was possible in five patients but completion duodenectomy was necessary in one patient. After total duodenectomy, immediate enteric duct drainage was feasible in seven patients. In two patients, a pancreaticocutaneous fistula was created that was subsequently converted to enteric drainage in one patient. In the other patient, enteric fistulization occurred as a consequence of silent pressure perforation of the draining catheter on the ascending colon. After a mean follow‐up period of 52 months (21‐125), all patients were alive, well, and insulin‐independent. An aggressive and timely surgical approach may permit graft rescue in patients with severe duodenal graft complications occurring after pancreas transplantation. Generalization of these results remains to be established. |
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| Keywords: | clinical decision‐making clinical research/practice complication: surgical/technical diagnostic techniques and imaging: computed tomography pancreas/simultaneous pancreas– kidney transplantation surgical technique |
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