Incidence and Histologic Features of Transplant Graft Pancreatitis: A Single Center Experience.

OBJECTIVES: Pancreas transplant is an effective long-term treatment modality for complicated type 1 diabetes mellitus. However, allograft failure or severe concomitant rejection remain an obstacle to successful transplant outcome, occurring in approximately 21% of recipients within 1 year. Most histologic studies investigating the cause of pancreas transplant failure have concentrated on the presence and severity of acute and chronic cellular or vascular rejection. After vascular thrombosis, graft pancreatitis is the second most frequent complication after transplant. MATERIALS AND METHODS: We conducted a retrospective analysis, collecting information from a contemporaneously maintained database of patients after pancreas transplant. RESULTS: We identified 44 patients with rejected allografts from a database of 196 pancreas transplant patients (44/196, 22%). In these identified rejected allografts, 27 patients (61%) had histopathology reports containing 1 or more terms associated with pancreatitis, with the most common histologic finding was being fat necrosis (21/27, 83%), followed by inflammatory or neutrophil infiltrate (13/27, 48%). Sixteen of these patients (60%) had two 2 or more terms histology terms descriptive of pancreatitis records. Ten of the 44 rejected allografts, 10 patients had histologic evidence of vascular or cellular rejection. There was no significant difference in the proportions showing evidence of rejection between groups with (2/27 patients [26%]) and without (3/17 patients [18%]) descriptions of pancreatitis in their medical records (P = .70). When time from transplant to pancreatectomy was analyzed, a larger proportion of pancreatectomies occurred late for patients with descriptions of pancreatitis in their medical records versus patients without (17/26 [65%] vs 4/16 [25%]; P = .05). CONCLUSIONS: This case series demonstrates that 61% of rejected allografts over a span of 13 years at a single center had histologic features of graft pancreatitis, suggesting that pancreatitis may be a contributory mechanism to graft failure.

Estudio cooperativo del Grupo Español de Trasplante de Páncreas (GETP): complicaciones quirúrgicas / Cooperative study of the Spanish Pancreas Transplant Group (GETP): Surgical complications

El fracaso técnico en el trasplante de páncreas ha sido el principal responsable de la pérdida de los injertos. Desde hace unos años, el número de complicaciones se han reducido, y por tanto, la proporción de este problema. Objetivos El Grupo Español del Trasplante de Páncreas se plantea como objetivo de este estudio analizar la situación actual con relación a las complicaciones quirúrgicas y su gravedad. Material y métodos Se ha realizado un estudio retrospectivo y multicéntrico con 10 centros participantes, con un total de 410 pacientes trasplantados de páncreas entre enero de 2008 y diciembre de 2013. Resultados Un total de 316 trasplantes fueron simultáneos con riñón, 66 después de riñón, 10 solo de páncreas, 7 multiviscerales y 11 retrasplantes. El porcentaje de complicaciones quirúrgicas fue del 39% (161 pacientes). Un 7% de trombosis vasculares, 13% de hemorragias, 6% de pancreatitis del injerto, 12% de infecciones quirúrgicas y otras en menor proporción. Las reintervenciones alcanzaron el 25%. La gravedad de las complicaciones fueron del tipo iiib (13%), del tipo ii (12%) y del tipo iva (8,5%). La pérdida del injerto fue del 8%. La mortalidad precoz del 0,5%. Las operaciones por complicaciones tardías fueron el 17%. Conclusiones El número de complicaciones quirúrgicas tras el trasplante no es desdeñable: afectan a uno de cada 3 pacientes, son graves en uno de cada 5 y con pérdida del injerto en uno de cada 10 pacientes. Por tanto, sigue existiendo un porcentaje significativo de complicaciones quirúrgicas en este tipo de actividad, como se demuestra en nuestro país

Technical failure in pancreas transplant has been the main cause of the loss of grafts. In the last few years, the number of complications has reduced, and therefore the proportion of this problem. Objetives The Spanish Pancreas Transplant Group wanted to analyze the current situation with regard to surgical complications and their severity. Material and methods A retrospective and multicenter study was performed. 10 centers participated, with a total of 410 pancreas transplant recipients between January and December 2013. Results A total of 316 transplants were simultaneous with kidney, 66 after kidney, pancreas-only 10, 7 multivisceral and 11 retrasplants. Surgical complication rates were 39% (n = 161). A total of 7% vascular thrombosis, 13% bleeding, 6% the graft pancreatitis, 12% surgical infections and others to a lesser extent. Relaparotomy rate was 25%. The severity of complications were of type IIIB (13%), type II (12%) and type IVA (8.5%). Graft loss was 8%. Early mortality was 0.5%. The percentage of operations for late complications was 17%. Conclusions The number of surgical complications after transplantation is not negligible, affecting one in 3 patients. They are severe in one out of 5 and, in one of every 10 patients graft loss occurs. Therefore, there is still a significant percentage of surgical complications in this type of activity, as shown in our country