Allograft Pancreatectomy: Indications and Outcomes

S. Nagai, J. A. Powelson, T. E. Taber, M. L. Goble, R. S. Mangus, J. A. Fridell

Research output: Contribution to journalArticle

11 Scopus citations

Abstract

This study evaluated the indications, surgical techniques, and outcomes of allograft pancreatectomy based on a single center experience. Between 2003 and 2013, 47 patients developed pancreas allograft failure, excluding mortality with a functioning pancreas allograft. Early graft loss (within 14 days) occurred in 16, and late graft loss in 31. All patients with early graft loss eventually required allograft pancreatectomy. Nineteen of 31 patients (61%) with late graft loss underwent allograft pancreatectomy. The main indication for early allograft pancreatectomy included vascular thrombosis with or without severe pancreatitis, whereas one recipient required urgent allograft pancreatectomy for gastrointestinal hemorrhage secondary to an arterioenteric fistula. In cases of late allograft pancreatectomy, graft failure with clinical symptoms such as abdominal discomfort, pain, and nausea were the main indications (13/19 [68%]), simultaneous retransplantation without clinical symptoms in 3 (16%), and vascular catastrophes including pseudoaneurysm and enteric arterial fistula in 3 (16%). Postoperative morbidity included one case each of pulmonary embolism leading to mortality, formation of pseudoaneurysm requiring placement of covered stent, and postoperative bleeding requiring relaparotomy eventually leading to femoro-femoral bypass surgery 2 years after allograftectomy. Allograft pancreatectomy can be performed safely, does not preclude subsequent retransplantation, and may be lifesaving in certain instances. The authors describe indications, surgical techniques, and outcomes of allograft pancreatectomy, which demonstrate that this procedure can be performed safely, does not preclude subsequent pancreas retransplantation, and may be lifesaving in certain instances.

Original languageEnglish (US)
Pages (from-to)2456-2464
Number of pages9
JournalAmerican Journal of Transplantation
Volume15
Issue number9
DOIs
StatePublished - Sep 1 2015

Keywords

  • Clinical research
  • complication
  • graft survival
  • pancreas
  • practice
  • retransplantation
  • sensitization
  • simultaneous pancreas-kidney transplantation
  • surgical
  • technical
  • thrombosis and thromboembolism

ASJC Scopus subject areas

  • Transplantation
  • Immunology and Allergy
  • Pharmacology (medical)

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  • Cite this

    Nagai, S., Powelson, J. A., Taber, T. E., Goble, M. L., Mangus, R. S., & Fridell, J. A. (2015). Allograft Pancreatectomy: Indications and Outcomes. American Journal of Transplantation, 15(9), 2456-2464. https://doi.org/10.1111/ajt.13287