Identification Of Failure Research Articles

Cause-aware failure detection using an interpretable XGBoost for optical networks.

Failure detection is an important part of failure management, and network operators encounter serious consequences when operating under failure conditions. Machine learning (ML) is widely applied in the failure management of optical networks, where neural networks (NNs) have particularly attracted considerable attention and become the most extensively applied algorithm among all MLs. However, the black-box nature of NN makes it difficult to interpret or analyze why and how NNs work during execution. In this paper, we propose a cause-aware failure detection scheme for optical transport network (OTN) boards, adopting the interpretable extreme gradient boosting (XGBoost) algorithm. According to the feature importance ranking by XGBoost, the high-relevance features with the equipment failure are found. Then, SHapley Additive exPlanations (SHAP) is applied to solve the inconsistency of feature attribution under three common global feature importance measurement parameters of XGBoost, and can obtain a consistent feature attribution by calculating the contribution (SHAP value) of each input feature to detection result of XGBoost. Based on the feature importance ranking of SHAP values, the features most related to two types of OTN board failures are confirmed, enabling the identification of failure causes. Moreover, we evaluate the failure detection performance for two types of OTN boards, in which the practical data are balanced and unbalanced respectively. Experimental results show that the F1 score of the two types of OTN boards based on the proposed scheme is higher than 98%, and the most relevant features of the two types of board failures are confirmed based on SHAP value, which are the average and maximum values of the environment temperature, respectively.

The Role of Satellite InSAR for Landslide Forecasting: Limitations and Openings

The paper explores the potential of the satellite advanced differential synthetic aperture radar interferometry (A-DInSAR) technique for the identification of impending slope failure. The advantages and limitations of satellite InSAR in monitoring pre-failure landslide behaviour are addressed in five different case histories back-analysed using data acquired by different satellite missions: Montescaglioso landslide (2013, Italy), Scillato landslide (2015, Italy), Bingham Canyon Mine landslide (2013, UT, USA), Big Sur landslide (2017, CA, USA) and Xinmo landslide (2017, China). This paper aimed at providing a contribution to improve the knowledge within the subject area of landslide forecasting using monitoring data, in particular exploring the suitability of satellite InSAR for spatial and temporal prediction of large landslides. The study confirmed that satellite InSAR can be successful in the early detection of slopes prone to collapse; its limitations due to phase aliasing and low sampling frequency are also underlined. According to the results, we propose a novel landslide predictability classification discerning five different levels of predictability by satellite InSAR. Finally, the big step forward made for landslide forecasting applications since the beginning of the first SAR systems (ERS and Envisat) is shown, highlighting that future perspectives are encouraging thanks to the expected improvement of upcoming satellite missions that could highly increase the capability to monitor landslides’ pre-failure behaviour.

A STRUCTURED FRAMEWORK FOR RELIABILITY AND RISK EVALUATION IN THE MILK PROCESS INDUSTRY UNDER FUZZY ENVIRONMENT

This paper aims at proposing a novel integrated framework for studying reliability and risk issues of the curd unit in a milk process industry under uncertain environment. The considered plant’s complex series-parallel configuration was presented using the Petri Net (PN) modeling. The Fuzzy Lambda-Tau (λ-τ) approach was applied to study and analyze the reliability aspects of the considered plant. Failure dynamics of the curd unit has been analyzed with respect to increasing/ decreasing trends of the tabulated reliability indices. Availability of the considered plant shows a decreasing trend with an increase in spread values. For improving the system’s availability, a risk analysis was done to identify the most critical failure causes. Using the traditional FMEA approach, the FMEA sheet was generated on the basis of expert’s knowledge/experience. The Fuzzy-Complex Proportional Assessment (FCOPRAS) approach was applied within FMEA approach for identification of critical failure causes associated with different subsystem/components of the considered plant. In order to check the consistency of the ranking results, the Fuzzy Technique for Order of Preference by Similarity to Ideal Solution (FTOPSIS) was applied within the FCOPRAS approach. Ranking results are compared for checking consistency and robustness of critical failure causes related decision making which would be useful in designing the finest maintenance schedule for the considered curd unit. Overheating/moisture lead to winding failure (MSCP5), visible sediment of milk jam in filter (MBFP3), improper quality of oil (H4), blade breakage (CTK4), wearing in gears (PFM11), and cylinder leakage (CFM7) were recognized as the most critical failure causes contributing to system unavailability. The analysis results were supplied to the maintenance manager for framing a suitable time-based maintenance intervals policy for the considered unit.

Human papilloma virus circulating tumor DNA assay predicts treatment response in recurrent/metastatic head and neck squamous cell carcinoma.

Despite the rising incidence of human papillomavirus related (HPV+) oropharyngeal squamous cell carcinoma (OPSCC), treatment of metastatic disease remains palliative. Even with new treatments such as immunotherapy, response rates are low and can be delayed, while even mild tumor progression in the face of an ineffective therapy can lead to rapid death. Real-time biomarkers of response to therapy could improve outcomes by guiding early change of therapy in the metastatic setting. Herein, we developed and analytically validated a new droplet digital PCR (ddPCR)-based assay for HPV16 circulating tumor DNA (ctDNA) and evaluated plasma HPV16 ctDNA for predicting treatment response in metastatic HPV+ OPSCC. We found that longitudinal changes HPV16 ctDNA correlate with treatment response and that ctDNA responses are observed earlier than conventional imaging (average 70 days, range: 35–166). With additional validation in multi-site studies, this assay may enable early identification of treatment failure, allowing patients to be directed promptly toward clinical trials or alternative therapies.

Application of a convolutional neural network for mooring failure identification

A novel application of a convolutional neural network (CNN) for the identification of mooring line failure of a turret-moored FPSO is demonstrated. The CNN was trained on images of the turret horizontal displacement history, simulated for both an intact mooring and a system with one line that had failed. When tested on operational and extreme environments representative of the North West Shelf of Australia, the CNN successfully distinguished between the turret responses associated with the intact and broken mooring. Classification accuracy was found to be lower for relatively benign conditions when the turret offset response was minimal. This was significantly improved through the use of additional hidden layers and retraining. As the CNN does not explicitly utilise metocean data as input, apart from training, it is envisaged that it offers an effective and lower-cost alternative to existing mooring failure detection approaches for the offshore industry.

Evaluation Of Novel Biomarkers For Early Detection Of Acute Kidney Injury In Children With B-Thalassemia Major

Background: Improved survival in patients with β-thalassemia has enabled the appearance of several clinical morbidities, involving renal problems. Incredibly important is the early detection of persons at higher risk of getting renal failure. Aim of work: To compare the sensitivity of KIM-1, NGAL and microalbuminuria in early detection of kidney injury in thalassemic children. Subjects and methods: A cross sectional study was conducted in the Outpatient Clinic of Hematology Unit of Pediatric Department and Clinical Pathology Department at Zagazig University Hospitals on thirty thalassemic patients during their regular follow-up visits and thirty age- and sex-matched healthy children as a control group from June to December 2017. All thalassemic patients were subjected to full medical history. Periodic thorough clinical examination was done with special emphasis on disease-related complications. Routine laboratory investigations were performed in addition to serum concentrations of Neutrophil Gelatinase-Associated Lipocalin (NGAL) protein (ng/ml), urine concentration of kidney injury molecule-1 (KIM-1) and microalbuminuria. Results: A highly statistically significant increase in the levels of urinary KIM-1, serum NGAL and albumin in urine among cases compared to controls was found. We found that the sensitivity of KIM-1 biomarker in prediction of kidney injury among thalassemia patients was 93.3%, higher than sensitivity of NGAL and microalbuminuria biomarkers. Conclusion: In early identification of acute renal failure in thalassemia patients, urinary KIM-1 is more sensitive than serum NGAL and microalbuminuria.

Early Identification of Extubation Failure Using Integrated Pulmonary Index and High-Risk Factors.

Early detection and prevention of extubation failure offers the potential to improve patient outcome. The primary aim of this study was to compare the predictive ability of the Integrated Pulmonary Index and presence of high-risk factors in determining extubation failure. A retrospective cross-sectional study of intubated adult subjects receiving mechanical ventilation for > 24 h was conducted at an academic medical center. The primary outcome was extubation failure, defined as the need for re-intubation or rescue noninvasive ventilation within 48 h after planned extubation. Among 216 subjects, 170 (78.7%) were successfully extubated, and 46 (21.3%) failed extubation. Extubation failure group had higher body mass index (26.21 vs 28.5 kg/m2, P = .033), rapid shallow breathing index during spontaneous breathing trial (43 vs 53.5, P = .02), and APACHE II score (11.86 vs 15.73, P < .001). Presence of ≥3 high-risk factors (odds ratio 3.11 [95% CI 1.32-7.31], P = .009), APACHE II > 12 on extubation day (odds ratio 2.98 [95% CI 1.22-7.27], P = .02), and Integrated Pulmonary Index decrease within 1 h after extubation (odds ratio 7.74 [95% CI 3.45-17.38], P < .001) were independently associated with extubation failure. The failed extubation group had higher ICU mortality (8.8% vs 19.6%; absolute difference 10.7% [95% CI -1.9% to 23.4%], P = .040) and hospital mortality (10% vs 22%; absolute difference 16.1% [95% CI 2.2-30%], P = .005) compared to the successful group. Among subjects receiving mechanical ventilation for > 24 h, decreasing Integrated Pulmonary Index within the first hour postextubation was a predictor of extubation failure and was superior to other weaning variables collected in this retrospective study. The presence of ≥ 3 high-risk factors was also independently associated with extubation failure. Future clinical studies are required to prospectively test the ability of postextubation Integrated Pulmonary Index monitoring to guide additional interventions designed to reduce re-intubation rates and improve patient outcome.

Emergency probability for aircraft vehicle

The probability of an emergency assessment is one of the most important problems in the aviation sector. Timely identification of possible equipment failure can be a solution of this problem, that saves people’s lives. The article considers existing methods for risk assessment. The comparison of these methods is carried out. As a result of this paper, the artificial neural network was designed. The set of vital input parameters was determined during the neural network development. All the input variables are divided into groups. The most promising and accurate approach for probability of an emergency assessing the was determined, which forms the basis of the mechanism for engineering accidents.

Non-invasive ventilation for SARS-CoV-2 acute respiratory failure: a subanalysis from the HOPE COVID-19 registry

BackgroundThe COVID-19 pandemic has seriously challenged worldwide healthcare systems and limited intensive care facilities, leading to physicians considering the use of non-invasive ventilation (NIV) for managing SARS-CoV-2-related acute respiratory failure...

Serum Procalcitonin in the Prediction of Severity and Outcome of Acute Pancreatitis

Background: Different modalities are available for predicting severity and outcome of acute pancreatitis. A single marker with high sensitivity and specificity is yet to be identified.&#x0D; Aim: This study intends to find out the utility of serum procalcitonin in predicting the severity and outcome of acute pancreatitis.&#x0D; Methods: 117 patients admitted with acute pancreatitis were included.Clinical parameters and biochemical tests were recorded on admission, on day-3 &amp; day-5 of admission. CT scan was performed in all patients. Serum procalcitonin was done on admission. Multifactorial scores were calculated using these data.Every patient was followed for identification of organ failure or other complications. Statistical analysis was done with SPSS.&#x0D; Result: Among 117 patients, 67(57.3%) were male. Biliary, hypertriglyceridemia, alcohol, malignancy and post-ERCP complications were found as aetiology in 25(21.4%), 23(19.7%), 8(6.8%), 3(2.6%),2(1.7%) cases respectively. In 53(45.3%) cases no definite etiology could be found. 83(70.9%) patients had mild,15(12.8%) had moderately severe and 19(16.2%) had severe acute pancreatitis. 23(19.65%) patients developed complication, whereas 94 (80.34%) developed none. The mean serum procalcitonin(pg/ml) of patients with mild, moderately severe and severe disease was 146±165.21, 1297±439.44, 4361±1493.55 respectively. The difference among the groups were statistically significant. Mean serum procalcitonin(pg/ml) in patientswho developed complications was 3744±1827.05 and in those without complication it was 301±559.97.ROC curve evaluating the role of serum procalcitonin in predicting outcome of acute pancreatitis showed AUC of 0.985. A cutoff point of 1131.28pg/ml showed highest sensitivity (95.7%) &amp; specificity (94.7%).&#x0D; Conclusion: Serum procalcitonin can be a new promising marker to predict severity and outcome of acute pancreatitis.&#x0D; Bangladesh Crit Care J March 2021; 9(1): 16-21

Facilitating Factors in the Proper Identification of Acute Skin Failure: A Systematic Review.

Acute skin failure is a significant medical finding for both the critical care patient and the hospital. Proper identification is key to prevention and treatment, but diagnosis of acute skin failure in critical care patients is often missed. This diagnostic oversight may be due to a lack of knowledge about acute skin failure and its presentation. To investigate the literature for facilitating factors that would ease the identification of acute skin failure for clinicians. The research team conducted a systematic literature review via PubMed, CINAHL, and Academic Search Ultimate to collect data about acute skin failure and how it might be identified. Ten common facilitation themes around acute skin failure and its identification were found in the literature. In total, 110 examples of facilitating factors were identified. There is little factual information available regarding the identification of acute skin failure, and the literature is lacking in this area overall. Acute skin failure may develop in the body in a number of ways, and understanding commonalities that occur in patients who experience acute skin failure and applying that information to patients in the future may assist identification.

Factors affecting CPAP compliance in patients with obstructive sleep apnea

Background/Aim: Continuous positive airway pressure (CPAP) is the most effective treatment for obstructive sleep apnea (OSA), but adequate patient compliance is required for treatment to achieve clinical success. This study aimed to determine factors affecting compliance with CPAP therapy in patients with OSA. Methods: In this retrospective cohort study, the records of patients that started CPAP treatment due to OSA between January 1, 2018 and August 30, 2020 were reviewed. The patients were divided into two groups based on their CPAP compliance: Group 1 included those who used CPAP regularly, and Group 2 included irregular users. Parameters such as age, gender, body mass index, apnea-hypopnea index, and educational status were compared between the groups. Results: Baseline apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) of patients using CPAP regularly were higher than irregular users (P=0.003, P=0.045, respectively). There was no significant difference between the groups in terms of age, gender, and body mass index (P=0.542, P=0.120 and P=0.796, respectively). In multivariate logistic regression analysis, low AHI, low ODI and low educational level were independent risk factors affecting CPAP compliance (P=0.010, P=0.016 and P=0.047, respectively). Conclusion: According to the results of this study, low AHI and ODI levels and low education status were risk factors for non-compliance with CPAP treatment. Therefore, patients with these features may require closer follow-up for early identification of CPAP treatment failure due to non-compliance.

Role of Neutrophil-Lymphocyte Ratio (NLR) in predicting development of organ failure in Acute Pancreatitis

Background: Different modalities are available for predicting development of organ failure in Acute Pancreatitis. A single marker with high sensitivity and specificity is yet to be identified. This study intends to find out the utility of Neutrophil Lymphocyte Ratio (NLR) in predicting development of organ failure in Acute Pancreatitis.&#x0D; Methods: A total of 117 patients admitted with acute pancreatitis were included. Clinical parameters and biochemical tests were recorded on admission and on day 3 &amp; day 5 of admission. CT scan was performed in all patients. NLRwas calculated using these data.Every patient was followed regularly for identification of organ failure. Statistical analysis was done with SPSS V22.&#x0D; Results: Among 117 patients, 67(57.3%) were male and 50(42.73%) were female with a mean age of 47.99±15. Among the patients the etiology was found to be biliary, hypertriglyceridemia, alcohol, malignancy and post-ERCP complications in 25(21.4%),23(19.7%),8(6.8%),3(2.6%),2(1.7%) cases respectively. In 53(45.3%) cases no definite etiology could be found. 83(70.9%) patients had mild,15(12.8%) had moderately severe and 19(16.2%) had severe acute pancreatitis. 23 (19.65%) patients developed complication, whereas 94 (80.34%) developed no complication.Organ failure was present in 34(29.06%) cases among total 117 cases.Those patients who developed organ failure had a mean NLR of 6.25±0.96, in contrast to a mean of 3.64±0.50 in those who didn’t developed organ failure.ROC curve evaluating the role of NLR in predicting development of organ failure in acute pancreatitis showed an AUC of 0.984. ROC curve revealed a cutoff point of 5.04 with highest sensitivity (97.1%) &amp; specificity (97.6%) with a PPV &amp; NPV of 94.3% &amp; 98.8% respectively.&#x0D; Conclusion: Calculating NLR is simple, it is readily available, easy to assess and cost-effective. It can be used as a new simple &amp; cost-effective marker for the prediction of development of organ failure in Acute Pancreatitis.&#x0D; Mediscope Vol. 8, No. 1: January 2021, Page 45-52

Multimodality cardiovascular imaging in pulmonary embolism

Acute pulmonary embolism (APE) is one of the leading causes of cardiovascular (CV) morbidity and mortality. To select appropriate therapeutic strategy and/or to minimize the mortality and morbidity, rapid and correct identification of life-threatening APE is very important. Also, right ventricular (RV) failure usually precedes acute hemodynamic compromise or death, and thus the identification of RV failure is another important step in risk stratification or treatment of APE. With advances in diagnosis and treatment, the prognosis of APE has been dramatically improving in most cases, but inadequate therapy or recurrent episodes of pulmonary embolism (PE) may result in negative outcomes or, so called, chronic thromboembolic pulmonary hypertension (CTEPH). CTEPH is a condition characterized by remaining chronic thromboembolic material in the pulmonary vasculature and subsequent chronic pulmonary hypertension. Various imaging modalities include chest computed tomography pulmonary angiography (CTPA), echocardiography, magnetic resonance imaging, and nuclear imaging and each are used for the assessment of varying status of PE. Assessment of thromboembolic burden by chest CTPA is the first step in the diagnosis of PE. Hemodynamic assessment can be achieved by echocardiography and also by chest CTPA. Nuclear imaging is useful in discriminating CTEPH from APE. Better perspectives on diagnosis, risk stratification and decision making in PE can be provided by combining multimodality CV imaging. Here, the advantages or pitfalls of each imaging modality in diagnosis, risk stratification, or management of PE will be discussed.

Acute liver failure in newborns.

Acute liver failure is a condition that is defined as a sudden, complete, or nearly complete loss of liver functions without any previous liver disease, usually accompanied by encephalopathy, which can be reversible, but with a mortality rate of 55-70%. Acute liver failure newborns is an acute liver failure in the first 28 days of life. The Pediatric Acute Liver Failure Working Group identified the presence of coagulopathy as the main finding for the identification of acute liver failure in childhood following vitamin K administration. Although the incidence of acute liver failure is reported to be 17/100 000 in all ages, its incidence is not known exactly in newborn and childhood. The most common cause of acute liver failure in the newborn period is the gestational alloimmune liver disease that was previously known as neonatal hemochromatosis. This is followed by viral infections, metabolic diseases, hemophagocytic lymphohistiocytosis, and other rare causes. In the neonatal period, acute liver failure is a rare condition with a high mortality rate. For this reason, the vital signs of the patients should be closely monitored and supportive treatments should be planned according to the follow-up and the etiology of the disease should be clarified urgently. In this process, acyclovir treatment until herpes simplex virus infection is excluded and lactose-free feeding until galactosemia is excluded are recommended as life-saving treatments. In the literature, since there is a limited number of studies related to neonatal acute liver failure, prospective studies investigating the factors affecting treatment and prognosis are needed.

The new role of musculoskeletal ultrasound in the treat-to-target management of juvenile idiopathic arthritis.

This article reviews the role of musculoskeletal ultrasound (MSUS) for the diagnosis, monitoring and treat-to-target management of JIA. Technological advancements in MSUS allow more precise evaluation of arthritis, tenosynovitis and enthesitis versus clinical examination alone, which may assist treatment decisions. In adult studies, serum and synovial biomarkers have correlated with MSUS findings. Within paediatric rheumatology, significant developments in the definition of normal and pathology, a necessity for the future integration of MSUS into treat-to-target management, have already been reached or are underway, which in turn could allow tighter control of disease activity and earlier identification of treatment response and failure, bringing the goal of 'precision medicine' closer. Additionally, the utility of MSUS for the evaluation of subclinical disease remains an unexamined area of interest. 'Ultrasound remission' combined with clinical assessment and immunological markers could therefore potentially improve the treat-to-target management of JIA.

Noninvasive ventilation and high-flow oxygen therapy for severe community-acquired pneumonia.

We review the evidence on the use of noninvasive respiratory supports (noninvasive ventilation and high-flow nasal cannula oxygen therapy) in patients with acute respiratory failure because of severe community-acquired pneumonia. Noninvasive ventilation is strongly advised for the treatment of hypercapnic respiratory failure and recent evidence justifies its use in patients with hypoxemic respiratory failure when delivered by helmet. Indeed, such interface allows alveolar recruitment by providing high level of positive end-expiratory pressure, which improves hypoxemia. On the other hand, high-flow nasal cannula oxygen therapy is effective in patients with hypoxemic respiratory failure and some articles support its use in patients with hypercapnia. However, early identification of noninvasive respiratory supports treatment failure is crucial to prevent delayed orotracheal intubation and protective invasive mechanical ventilation. Noninvasive ventilation is the first-line therapy in patients with acute hypercapnic respiratory failure because of pneumonia. Although an increasing amount of evidence investigated the application of noninvasive respiratory support to hypoxemic respiratory failure, the optimal ventilatory strategy in this setting is uncertain. Noninvasive mechanical ventilation delivered by helmet and high-flow nasal cannula oxygen therapy appear as promising tools but their role needs to be confirmed by future research.

A retrospective observational study of daytime and nighttime transfers from the intensive care unit: through the lens of critical care response teams.

To evaluate the impact of nighttime compared with daytime transfers from the intensive care unit (ICU) on mortality in a hospital with a critical care response team (CCRT). We performed a retrospective observational study of ICU patients transferred between January 2011 and July 2013 who received CCRT follow-up. The transferred patients were divided into cohorts of daytime and nighttime transfers. A multivariable logistic regression model was used to identify independent predictors of mortality after ICU transfer. There were 1,857 patients included in the study. With the exception of Multiple Organ Dysfunction Score on admission, transfers to a step-down unit, and lower urine output, there were no differences in the baseline characteristics, clinical events identified by CCRTs, and the number of CCRT interventions performed between daytime and nighttime transfers. Patients transferred at night were at higher risk of death in the univariate analysis but not in the multivariate analysis. Independent predictors of mortality included older age (odds ratio [OR], 1.02; 95% confidence interval [CI], 1.002 to 1.04), transfer to a medical service (OR, 1.96; 95% CI, 1.11 to 3.43), CCRT identification of hypoxemic respiratory failure (OR, 5.86; 95% CI, 3.11 to 11.04), decreased level of consciousness (OR, 3.14; 95% CI, 1.23 to 8.02), hypotension (OR, 3.69; 95% CI, 1.36 to 10.01), and longer CCRT duration of follow-up (OR, 1.02; 95% CI, 1.004 to 1.03). Nighttime transfer from the ICU was not an independent predictor of mortality. We identified unique predictors of mortality, including clinical events that CCRTs identified in patients immediately after ICU transfer. Future studies are required to validate these predictors of mortality in transferred ICU patients.

Challenges in the Performance of Awake Craniotomies in the Philippine General Hospital: A Case Series

Awake craniotomy is a neurosurgical technique that involves an awake neurological testing during the resection of an intracranial lesion in eloquent cerebral cortical areas representing motor, language, and speech. This technique is highlighted by an intra-operative cortical mapping that requires active participation by the patient and poses unique challenges to the anesthesiologist. The surgical and anesthetic techniques have evolved significantly over time, as the neurosurgeon and the anesthesiologist learn new steps in making this technique safe to achieve reasonable patient satisfaction. A thorough understanding of this surgical technique's rationale will guide the anesthesiologist in planning the anesthetic management depending on the surgery and neurologic testing. Constant communication between the neurosurgeon, anesthesiologist, and the patient will define this surgical technique's success. It is already a well-established procedure; however, factors that contribute to failures in awake craniotomy procedures have not been well characterized in the literature. Failure is defined as the inability to conduct awake neurologic testing during the awake craniotomy procedure because of various factors which will be described. This paper aims to review the challenges in the performance of three (3) cases of awake craniotomies performed in the Philippine General Hospital. The challenges described in these three (3) cases reveal that this can be experienced by the neurosurgeon, neuroanesthesiologist, and most especially the patient in an acute critical condition. Identification of the procedures' failure and the steps taken to manage such situations with the patient's safety in mind are discussed.

Exocrine drainage in pancreas transplantation: Complications and management.

The aim of this minireview is to compare various pancreas transplantation exocrine drainage techniques i.e., bladder vs enteric. Both techniques have different difficulties and complications. Numerous comparisons have been made in the literature between exocrine drainage techniques throughout the history of pancreas transplantation, detailing complications and their impact on graft and patient survival. Specific emphasis has been made on the early postoperative management of these complications and the related surgical infections and their consequences. In light of the results, a number of bladder-drained pancreas grafts required conversion to enteric drainage. As a result of technical improvements, outcomes of the varied enteric exocrine drainage techniques (duodenojejunostomy, duodenoduodenostomy or gastric drainage) have also been discussed i.e., assessing specific risks vs benefits. Pancreatic exocrine secretions can be drained to the urinary or intestinal tracts. Until the late 1990s the bladder drainage technique was used in the majority of transplant centers due to ease of monitoring urine amylase and lipase levels for evaluation of possible rejection. Moreover, bladder drainage was associated at that time with fewer surgical complications, which in contrast to enteric drainage, could be managed with conservative therapies. Nowadays, the most commonly used technique for proper driving of exocrine pancreatic secretions is enteric drainage due to the high rate of urological and metabolic complications associated with bladder drainage. Of note, 10% to 40% of bladder-drained pancreata eventually required enteric conversion at no detriment to overall graft survival. Various surgical techniques were originally described using the small bowel for enteric anastomosis with Roux-en-Y loop or a direct side-to-side anastomosis. Despite the improvements in surgery, enteric drainage complication rates ranging from 2%-20% have been reported. Treatment depends on the presence of any associated complications and the condition of the patient. Intra-abdominal infection represents a potentially very serious problem. Up to 30% of deep wound infections are associated with an anastomotic leak. They can lead not only to high rates of graft loss, but also to substantial mortality. New modifications of established techniques are being developed, such as gastric or duodenal exocrine drainage. Duodenoduodenostomy is an interesting option, in which the pancreas is placed behind the right colon and is oriented cephalad. The main concern of this technique is the challenge of repairing the native duodenum when allograft pancreatectomy is necessary. Identification and prevention of technical failure remains the main objective for pancreas transplantation surgeons. In conclusion, despite numerous techniques to minimize exocrine pancreatic drainage complications e.g., leakage and infection, no universal technique has been standardized. A prospective study/registry analysis may resolve this.