RISK FACTORS FOR INTRA-ABDOMINAL INFECTION AFTER PANCREAS TRANSPLANTATION

Abstract

341 Intra-abdominal infection is a well described complication of whole organ pancreas transplantation, resulting in considerable morbidity and graft loss. This study was designed to determine risk factors for the development of peri-pancreatic abscess after pancreas transplantation for type I diabetes. Methods: We performed a single center retrospective review of 34 consecutive pancreas transplants from 1994-1998. Risk factors studied were donor age, body weight, body mass index, peak serum glucose, peak serum amylase, need for pressor agents, cause of death (traumatic vs. nontraumatic), cold ischemic preservation time, recipient age, type of dialysis (none, hemo, PD), surgical technique (bladder vs. enteric drainage), and peak recipient amylase. Results: The overall one year actuarial graft survival rate was 90%. Within this cohort, one graft was lost in the first post-operative week due to thrombosis and was excluded from the subsequent analysis. Of the remaining 33 patients, there were 4 cases of peri-pancreatic abscess formation (12%) all of which occurred within the first post-operative month. All cases were successfully managed by a combination of open surgical and closed percutaneous drainage. One patient required graft pancreatectomy. Both donor body weight (mean 86±8 vs. 68±11 kgs, p<0.001) and donor body mass index (27.3±2.5 vs. 23.1±3.2 kg/m2, p<0.05) were significantly higher for patients that later developed pancreatic abscess compared to the control group. Among recipient factors, the peak recipient serum amylase in the first postoperative week was significantly higher (median 818±1524 vs. 181±278 U/L, p<0.05) in patients who later developed intra-abdominal sepsis compared to the unaffected cohort. To confirm these findings, each risk factor was studied one at a time using exact logistic regression analysis. Again, elevated donor body weight (p<0.01), elevated donor body mass index (p<0.05) and the peak recipient serum amylase in the first post-operative week (p<0.01) were significant risk factors for the development of intra-abdominal infection. No other donor or recipient risk factor studied was associated with pancreatic abscess. Conclusion: This data suggests that pancreas grafts from obese donors may be more susceptible to ischemia-reperfusion injury resulting in abscess formation. Avoidance of overweight donors, careful inspection of pancreas grafts for fatty infiltration and the prophylactic use of octreotide are potential interventions to avoid this devastating complication.