Re-operation in pancreas transplantation

Background: Surgical complications in pancreas transplantation are associated with increased morbidity and graft loss. The purpose of our study was to determine the frequency of re-operation in early and late postoperative of pancreas transplantation and its impact in relation to graft survival, patient survival, and hospital mortality. Methods: We conducted a retrospective study of 238 pancreas transplants performed from 2001 to 2011. We analyzed surgical complications that led to the early and late reoperations by type of transplantation and its relation to pancreas graft survival, patient survival, and hospital mortality. Results: We studied 61 re-operated patients (25.63%), 58 patients with early reoperation and 3 with late re-operation. The median of re-operations per patient was 1.48 (range, 1 to 5). Seventy-five surgical complications required 90 re-operations. The causes of early re-operations were bleeding (8.8%), pancreas graft thrombosis (6.3%), pancreatitis (2.9%), bowel obstruction (2.1%), leaks (2.1%), and evisceration (1.7%). The hospital mortality rate was 0.43%. Pancreas graft survival at 1 and 5 years is higher in the group of nonere-operated than in the re-operated group (98% vs 74% and 93% vs 57%; P =.0001). Patient survival at 1 year is slightly higher in the nonere-operated group, but with no significant differences (99% vs 97%), and at 5 years the patient survival in the nonere-operated group is higher than in the re-operated group (98% vs 91%; P =.011). Conclusions: Surgical complications required re-operations that were associated with higher morbidity and lower pancreas graft and patient survival.