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Original Communications| Volume 127, ISSUE 5, P545-551, May 2000

Prolonged preservation increases surgical complications after pancreas transplants

      Abstract

      Background. Prolonged preservation of the donor organ may result in delayed graft function or non-function after most organ transplants. We studied whether or not prolonged preservation increases surgical complications after pancreas transplants. Methods. Between January 1, 1994, and September 30, 1998, a total of 294 recipients underwent cadaver pancreas transplants at our institution. Recipients were analyzed in 2 groups: those with pancreas preservation time ≤ 20 hours (n = 211) versus > 20 hours (n = 83). Results. Demographic data were similar between the 2 groups, except that mean donor age in the prolonged preservation group was significantly lower. Despite use of younger donors, prolonged preservation was associated with an increased incidence of surgical complications, most notably leaks, thrombosis, and wound infections. Grafts with prolonged preservation were more often noted by the transplant surgeon to be edematous after reperfusion, although the incidence of hyperamylasemia posttransplant did not differ between the 2 groups. Graft and patient survival rates also did not differ between the 2 groups. The incidence of early graft loss (< 3 months) was, however, higher in the prolonged preservation group (20.5% versus 9.0%, P =.04). Conclusions. Prolonged preservation of the donor organ increases the incidence of surgical complications after pancreas transplants. All attempts should be made to minimize preservation time, keeping it below 20 hours, if possible. (Surgery 2000;127:545–51)
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      References

        • Belzer FO
        • Southard JH
        Principles of solid-organ preservation by cold storage.
        Transplantation. 1988; 45: 673-676
        • D'Alessandro AM
        • Stratta RJ
        • Sollinger HW
        • et al.
        Use of UW solution in pancreas transplantation.
        Diabetes. 1989; 38: 7-9
        • Abouna GM
        • Sutherland DER
        • Florack G
        • et al.
        Function of transplanted human pancreatic allografts after preservation in cold storage for 6 to 26 hours.
        Transplantation. 1987; 43: 630-636
        • Koning OH
        • Ploeg RJ
        • van Bockel JH
        • et al.
        Risk factors for delayed graft function in cadaveric kidney transplantation: a prospective study of renal function and graft survival after preservation with University of Wisconsin solution in multi-organ donors.
        Transplantation. 1997; 63: 1620-1628
        • Porte RJ
        • Ploey RJ
        • Hansen B
        • et al.
        Long-term graft survival after liver transplantation in the UW era: late effects of cold ischemia and primary dysfunction.
        Transplant Int. 1998; 11: S164-S167
        • Morel P
        • Moudry-Munns K
        • Najarian JS
        • et al.
        Influence of preservation time on outcome and metabolic function of bladder-drained pancreas transplants.
        Transplantation. 1990; 49: 294-303
        • Schaapherder AF
        • de Roos A
        • Shaw PC
        • et al.
        The role of early baseline computed tomography in the interpretation of morphological changes after kidney-pancreas transplantation.
        Transplant Int. 1993; 6: 270-276
        • Gruessner RWG
        • Sutherland DER
        Pancreas transplantation: Part I: The donor operation.
        Surg Rounds. 1994; 17: 311-324
        • Gruessner RWG
        • Sutherland DER
        Pancreas transplantation: Part II: The recipient operation.
        Surg Rounds. 1994; 17: 383-391
        • Gruessner RWG
        • Dunn DL
        • Gruessner AC
        • et al.
        Recipient risk factors have an impact on technical failure and patient and graft survival rates in bladder-drained pancreas transplants.
        Transplantation. 1994; 57: 1598-1606
        • Troppmann C
        • Gruessner AC
        • Sutherland DER
        • et al.
        Surgical complications requiring early relaparotomy after pancreas transplantation: a multivariate risk factor and economic impact analysis.
        Ann Surg. 1998; 227: 255-268
        • Troppmann C
        • Gruessner AC
        • Benedetti E
        • et al.
        Vascular graft thrombosis after pancreatic transplantation: univariate and multivariate operative and nonoperative risk factor analysis.
        J Am Coll Surg. 1996; 182: 285-316
        • Gruessner RWG
        • Sutherland DER
        Clinical diagnosis in pancreatic allograft rejection.
        in: Solid organ transplant rejection: mechanism, pathology, and diagnosis. : Marcel Dekker, Inc, New York1996: 455-489
        • Gruessner RWG
        • Sutherland ER
        • Troppmann C
        • et al.
        The surgical risk of pancreas transplantation in the cyclosporine era: an overview.
        J Am Coll Surg. 1997; 185: 128-143
        • Lopez-Medrano RM
        • Ponce J
        • Varela G
        • et al.
        Extensive decrease in insulin secretion by the pancreas preserved for 24 hours in UW-1 solution.
        Transplant Proc. 1991; 23: 1676-1678
        • Sutherland DE
        Report from the International Pancreas Transplant Registry.
        Diabetologia. 1991; 34: S28
        • Tamsma JT
        • Schaapherder A
        • van Bronswijk H
        • et al.
        Islet cell hormone release immediately after human pancreatic transplantation.
        Transplantation. 1993; 56: 1119-1123
        • Rodriguez FJ
        • Toledo-Pereyra LH
        • Suzuki S
        Twenty-four-hour total small bowel hypothermic storage preservation and transplantation in the rat: a study of various preservation solutions.
        J Invest Surg. 1994; 7: 439-451
        • Balen E
        • Cienfuegos JA
        • Montuenga L
        • et al.
        Assessment of intestinal preservation injury and duodenal rejection in a multivisceral allotransplantation model in the pig.
        Transplant Proc. 1996; 28: 2646-2647
        • Heise J
        • Sutherland DER
        • Heil J
        • et al.
        72-hour preservation of pancreatic autotransplants in dogs using a urinary drainage technique.
        Transplant Proc. 1988; 20: 1029
        • Florack G
        • Sutherland DER
        • Morel P
        • et al.
        Effective preservation of human pancreas grafts.
        Transplant Proc. 1989; 21: 1369
        • Florack G
        • Sutherland DER
        • Heil J
        • et al.
        Long-term preservation of segmental pancreas autografts.
        Surgery. 1982; 92: 260
        • Largiader F
        • Baumgartner D
        • Uhlschid G
        Ischemia tolerance of human pancreatic transplants.
        Transplant Proc. 1984; 16: 1285-1286