Technical failures after pancreas transplants: Why grafts fail and the risk factors - A multivariate analysis

Abhinav Humar, Thigarajan Ramcharan, Raja Kandaswamy, Rainer W G Gruessner, Angelika C Gruessner, David E R Sutherland

Research output: Contribution to journalArticle

149 Citations (Scopus)

Abstract

Background. Technical failure (TF) rates remain high after pancreas transplants; while rates have decreased over the last decade, more than 10% of all pancreas grafts continue to be lost due to technical reasons. We performed a multivariate analysis to determine causes and risk factors for TF of pancreas grafts. Results. Between 1994 and 2003, 937 pancreas transplants were performed at our center in the following transplant categories: simultaneous pancreas-kidney (SPK) (n=327), pancreas after kidney (PAK) (n=399), and pancreas transplant alone (PTA) (n=211). Of these, 123 (13.1%) grafts were lost due to technical reasons (thrombosis, leaks, infections). TF rates were higher for SPK (15.3%) versus PAK (12.2%) or PTA (11.4%), though this was not statistically significant. Thrombosis accounted for 52.0% of all TFs. Other causes were infections (18.7%), pancreatitis (20.3%), leaks (6.5%), and bleeding (2.4%). Thrombosis was the most common cause for TF in all three transplant categories. By multivariate analysis, the following were significant risk factors for TF of the graft: recipient body mass index (BMI) >30 kg/m2 (relative risk [RR]=2.42, P=0.0003), preservation time >24 hr (1.87, P=0.04), cause of donor death other than trauma (RR=1.58, P=0.04), enteric versus bladder drainage (1.68, P=0.06), and donor BMI >30 kg/m2 (1.66, P=0.06). Not significant were donor or recipient age, a retransplant, and the category of transplant. Conclusions. TFs remain significant after pancreas transplants. In SPK recipients, TF represents the most common cause of pancreas graft loss. For isolated pancreas transplants, TF is second only to rejection as a cause of graft loss. Increased preservation times and donor or recipient obesity seem to be risk factors. Minimizing these risks factors would be important to try to decrease TF.

Original languageEnglish (US)
Pages (from-to)1188-1192
Number of pages5
JournalTransplantation
Volume78
Issue number8
DOIs
StatePublished - Oct 27 2004
Externally publishedYes

Fingerprint

Pancreas
Multivariate Analysis
Transplants
Kidney
Thrombosis
Body Mass Index
Infection
Pancreatitis
Drainage
Cause of Death
Urinary Bladder
Obesity
Hemorrhage

Keywords

  • Pancreas transplants
  • Surgical complications

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Technical failures after pancreas transplants : Why grafts fail and the risk factors - A multivariate analysis. / Humar, Abhinav; Ramcharan, Thigarajan; Kandaswamy, Raja; Gruessner, Rainer W G; Gruessner, Angelika C; Sutherland, David E R.

In: Transplantation, Vol. 78, No. 8, 27.10.2004, p. 1188-1192.

Research output: Contribution to journalArticle

Humar, Abhinav ; Ramcharan, Thigarajan ; Kandaswamy, Raja ; Gruessner, Rainer W G ; Gruessner, Angelika C ; Sutherland, David E R. / Technical failures after pancreas transplants : Why grafts fail and the risk factors - A multivariate analysis. In: Transplantation. 2004 ; Vol. 78, No. 8. pp. 1188-1192.
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abstract = "Background. Technical failure (TF) rates remain high after pancreas transplants; while rates have decreased over the last decade, more than 10{\%} of all pancreas grafts continue to be lost due to technical reasons. We performed a multivariate analysis to determine causes and risk factors for TF of pancreas grafts. Results. Between 1994 and 2003, 937 pancreas transplants were performed at our center in the following transplant categories: simultaneous pancreas-kidney (SPK) (n=327), pancreas after kidney (PAK) (n=399), and pancreas transplant alone (PTA) (n=211). Of these, 123 (13.1{\%}) grafts were lost due to technical reasons (thrombosis, leaks, infections). TF rates were higher for SPK (15.3{\%}) versus PAK (12.2{\%}) or PTA (11.4{\%}), though this was not statistically significant. Thrombosis accounted for 52.0{\%} of all TFs. Other causes were infections (18.7{\%}), pancreatitis (20.3{\%}), leaks (6.5{\%}), and bleeding (2.4{\%}). Thrombosis was the most common cause for TF in all three transplant categories. By multivariate analysis, the following were significant risk factors for TF of the graft: recipient body mass index (BMI) >30 kg/m2 (relative risk [RR]=2.42, P=0.0003), preservation time >24 hr (1.87, P=0.04), cause of donor death other than trauma (RR=1.58, P=0.04), enteric versus bladder drainage (1.68, P=0.06), and donor BMI >30 kg/m2 (1.66, P=0.06). Not significant were donor or recipient age, a retransplant, and the category of transplant. Conclusions. TFs remain significant after pancreas transplants. In SPK recipients, TF represents the most common cause of pancreas graft loss. For isolated pancreas transplants, TF is second only to rejection as a cause of graft loss. Increased preservation times and donor or recipient obesity seem to be risk factors. Minimizing these risks factors would be important to try to decrease TF.",
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T2 - Why grafts fail and the risk factors - A multivariate analysis

AU - Humar, Abhinav

AU - Ramcharan, Thigarajan

AU - Kandaswamy, Raja

AU - Gruessner, Rainer W G

AU - Gruessner, Angelika C

AU - Sutherland, David E R

PY - 2004/10/27

Y1 - 2004/10/27

N2 - Background. Technical failure (TF) rates remain high after pancreas transplants; while rates have decreased over the last decade, more than 10% of all pancreas grafts continue to be lost due to technical reasons. We performed a multivariate analysis to determine causes and risk factors for TF of pancreas grafts. Results. Between 1994 and 2003, 937 pancreas transplants were performed at our center in the following transplant categories: simultaneous pancreas-kidney (SPK) (n=327), pancreas after kidney (PAK) (n=399), and pancreas transplant alone (PTA) (n=211). Of these, 123 (13.1%) grafts were lost due to technical reasons (thrombosis, leaks, infections). TF rates were higher for SPK (15.3%) versus PAK (12.2%) or PTA (11.4%), though this was not statistically significant. Thrombosis accounted for 52.0% of all TFs. Other causes were infections (18.7%), pancreatitis (20.3%), leaks (6.5%), and bleeding (2.4%). Thrombosis was the most common cause for TF in all three transplant categories. By multivariate analysis, the following were significant risk factors for TF of the graft: recipient body mass index (BMI) >30 kg/m2 (relative risk [RR]=2.42, P=0.0003), preservation time >24 hr (1.87, P=0.04), cause of donor death other than trauma (RR=1.58, P=0.04), enteric versus bladder drainage (1.68, P=0.06), and donor BMI >30 kg/m2 (1.66, P=0.06). Not significant were donor or recipient age, a retransplant, and the category of transplant. Conclusions. TFs remain significant after pancreas transplants. In SPK recipients, TF represents the most common cause of pancreas graft loss. For isolated pancreas transplants, TF is second only to rejection as a cause of graft loss. Increased preservation times and donor or recipient obesity seem to be risk factors. Minimizing these risks factors would be important to try to decrease TF.

AB - Background. Technical failure (TF) rates remain high after pancreas transplants; while rates have decreased over the last decade, more than 10% of all pancreas grafts continue to be lost due to technical reasons. We performed a multivariate analysis to determine causes and risk factors for TF of pancreas grafts. Results. Between 1994 and 2003, 937 pancreas transplants were performed at our center in the following transplant categories: simultaneous pancreas-kidney (SPK) (n=327), pancreas after kidney (PAK) (n=399), and pancreas transplant alone (PTA) (n=211). Of these, 123 (13.1%) grafts were lost due to technical reasons (thrombosis, leaks, infections). TF rates were higher for SPK (15.3%) versus PAK (12.2%) or PTA (11.4%), though this was not statistically significant. Thrombosis accounted for 52.0% of all TFs. Other causes were infections (18.7%), pancreatitis (20.3%), leaks (6.5%), and bleeding (2.4%). Thrombosis was the most common cause for TF in all three transplant categories. By multivariate analysis, the following were significant risk factors for TF of the graft: recipient body mass index (BMI) >30 kg/m2 (relative risk [RR]=2.42, P=0.0003), preservation time >24 hr (1.87, P=0.04), cause of donor death other than trauma (RR=1.58, P=0.04), enteric versus bladder drainage (1.68, P=0.06), and donor BMI >30 kg/m2 (1.66, P=0.06). Not significant were donor or recipient age, a retransplant, and the category of transplant. Conclusions. TFs remain significant after pancreas transplants. In SPK recipients, TF represents the most common cause of pancreas graft loss. For isolated pancreas transplants, TF is second only to rejection as a cause of graft loss. Increased preservation times and donor or recipient obesity seem to be risk factors. Minimizing these risks factors would be important to try to decrease TF.

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KW - Surgical complications

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