Pancreatic Complications After Intestinal Transplantation

Abstract

Purpose: To analyze the impact of pancreatic complications on the final outcome of patients with intestinal failure following intestinal transplantation (Itx). Materials and Methods: Nine patients underwent primary isolated Itx at our hospital between 2003 and 2016. Median patient age at the time of primary Itx was 22 years (range, 10-29 years). No patients had any history of pancreatic disease before Itx. Recipients were classified into a Pancreatic group (n=3) with pancreatic complications following Itx, and a Control group (n=6) without such complications. No recipients sustained pancreatic injuries or developed acute pancreatitis as intraoperative or immediately postoperative complications of Itx. We retrospectively analyzed several clinical parameters and compared outcomes between the groups. Results: One of 3 patients in the Pancreatic group, who was associated with duodenal obstruction, developed acute severe pancreatitis 115 months following Itx. She died 2 months later. Another patient died of abdominal bleeding due to laceration of the pancreas, presumably related to extensive dilation of the duodenum without abdominal bruising 87 months after Itx, and acute pancreatitis was revealed at autopsy. The remaining patient developed refractory bleeding of the pancreas 5 months after Itx. Bleeding was well controlled conservatively and the patient remains alive with a functioning graft. The underlying disease was motility disorder (MD) in all 3 patients in the pancreatic group, but was MD in 3 cases and short bowel syndrome in 3 cases in the control group. Median follow-up was 87 months in the pancreatic group and 90 months in the control group. Overall, 1- and 5-year survival rates were 33.3%, 100% and 100%, and 83.3%, 100% and 83.3% in pancreatic and control groups, respectively. Larger hemorrhages were encountered in the pancreatic group (median, 2,866 ml) than in the control group (1,919 ml) during Itx (p=0.02). No significant differences were found in other parameters, including operative time, graft condition, and rejection rates between groups. Conclusion: We speculate that patients with MD were associated with considerably high risk of severe pancreatitis. Large hemorrhage during Itx might be another risk factor for pancreatic complications. However, the mechanisms of such complications remain unclear. We encountered lethal pancreatic complications following Itx, and special attention should be paid to patients with MD with/without dilated duodenum following Itx.