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. 2017 Jun 23;3(7):e179.
doi: 10.1097/TXD.0000000000000698. eCollection 2017 Jul.

Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts

David Al-Adra  1 , Ian McGilvray  1 , Nicolas Goldaracena  1 , Vinzent Spetzler  1 , Jerome Laurence  2 , Andrea Norgate  1 , Max Marquez  1 , Paul Greig  1 , Gonzalo Sapisochin  1 , Jeffrey Schiff  3 , Sunita Singh  3 , Markus Selzner  1 , Mark Cattral  1
Affiliations

Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts

David Al-Adra et al. Transplant Direct. .

Abstract

Background: Duodenal leak remains a major cause of morbidity and graft loss in pancreas transplant recipients. The role and efficacy of surgical and image-guided interventions to salvage enterically drained grafts with a duodenal leak has yet to be defined.

Methods: We investigated the incidence, treatment, and outcome of duodenal leak in 426 pancreas transplantation recipients from 2000 to 2015.

Results: Duodenal leak developed in 33 (7.8%) recipients after a median follow-up of 5.3 (range, 0.5-15.2) years. Most leaks occurred during the first year (n = 22; 67%), and most were located near the proximal and distal duodenal staple line. Graft pancreatectomy was performed in 8 patients as primary therapy because of unfavorable local and/or systemic conditions. Salvage was attempted in 25 patients using percutaneous drainage (n = 4), surgical drainage (n = 4), or surgical repair (n = 17). Percutaneous or surgical drainage failed to control the leak in 7 of these 8 patients, and all 7 ultimately required graft pancreatectomy for persistent leak and sepsis. Surgical repair salvaged 14 grafts, and 13 grafts continue to function after a median follow-up of 2.9 (range, 1.1-6.3) years after repair.

Conclusions: Our study shows that in selected patients a duodenal leak can be repaired successfully and safely in enterically drained grafts.

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Conflict of interest statement

The authors declare no funding or conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Time from transplant to diagnosis of duodenal leak. Insert—leaks within the first year.
See this image and copyright information in PMC

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