Management of complications of simultaneous kidney-pancreas transplantation with temporary venting jejunostomy

Abstract

The majority of simultaneous kidney-pancreas (SPK) transplants are being performed with portal-enteric drainage, which does not allow easy access to the donor pancreas. By adding a temporary venting jejunostomy (TVJ) we have been able to closely monitor patients for bleeding, anastomotic leak and rejection.

Methods: Retrospective chart review of 29 patients undergoing SPK with PE drainage from December 1996 to December 2001.

Results: Median follow-up was 32 months. Patient, kidney and pancreas graft survival were 93%, 90% and 93%, respectively. The most common early complications were wound infections and bleeding. No patient suffered vessel thrombosis. The most common late (greater than 3 months post-transplant) complication was gastro-intestinal bleeding. Adequate tissue was obtained for biopsy in 100% of patients with suspected pancreatic rejection. The TVJ allowed one patient to undergo donor pancreas ERCP that demonstrated the site of a pancreatic duct leak. Duodenal stump leak and anastomotic bleeding were diagnosed in one patient each via the TVJ. The median time to takedown of the TVJ was 14 months.

Conclusion: TVJ allows patients an easy method of graft surveillance, is well tolerated, and has an acceptable complication rate. The TVJ allows access to diagnose anastomotic leak, cauterize bleeding mucosa, perform ERCP and biopsy the pancreas allograft.