Infectious complications following 72 consecutive enteric-drained pancreas transplants

Abstract

Summary New immunosuppressive protocols and advanced surgical technique resulted in an improved outcome of pancreatic transplantation (PTx) with infection remaining the most common complication. Seventy‐two enteric‐drained whole PTxs performed at the Innsbruck University Hospital between September 2002 and October 2004 were retrospectively analyzed. Prophylactic immunosuppression consisted of either the standard protocol consisting of single bolus antithymocyteglobuline (ATG) (Thymoglobulin, Sangstat or ATG Fresenius) induction (9 mg/kg), tacrolimus (TAC), mycophenylate mofetil (MMF) and steroids (38 patients) or a 4‐day course of ATG (4 mg/kg) tacrolimus and steroids with MMF (n = 19), or Sirolimus (n = 15). Perioperative antimicrobial prophylaxis consisted of Piperacillin/Tazobactam (4.5 g q 8 h) in combination with ciprofloxacin (200 mg q 12 h) and fluconazole (400 mg daily). Ganciclovir was used for cytomegalovirus (CMV) prophylaxis if donor was positive and recipient‐negative. Patient, pancreas, and kidney graft survival at 1 year were 97.2%, 88.8%, and 93%, respectively, with no difference between the groups. All retransplants (n = 8) and single transplants (n = 8) as well as all type II diabetics and nine of 11 patients older 55 years received standard immunosuppression (IS). The rejection rate was 14% and infection rate 46% with no difference in terms of incidence or type according to the three groups. Severe infectious complications included intra‐abdominal infection (n = 12), wound infection (n = 7), sepsis (n = 13), respiratory tract infection (n = 4), urinary tract infection (n = 12), herpes simplex/human herpes virus 6 infection (n = 5), CMV infection/disease (n = 7), post‐transplant lymphoproliferative disorder (PTLD, n = 3), invasive filamentous fungal infection (n = 4), Clostridial/Rotavirus colitis (n = 1), and endocarditis (n = 1). All four patients in this series died of infectious complications (invasive aspergillosis n = 2) (one with Candida glabrata superinfection), invasive zygomycosis (n = 1), PTLD (n = 1). Five grafts were lost (vascular thrombosis n = 3, pancreatitis n = 1, noncompliance n = 1). Infection represented the most frequent complication in this series and all four deaths were of infectious origin. Better prophylaxis and management of infections now should be the primary target to be addressed in the field of pancreas transplantation.

Influence of donor- and recipient-specific factors on the postoperative course after combined pancreas–kidney transplantation

“…In contrast with other studies [25,26] where a higher prevalence of abdominal infections in patients who underwent enteric drainage was noted, we found that the type of drainage had no relationship to any type of complication. In accordance with other studies [27], we showed that the use of daclizumab as a nondepleting T-cell antibody tends to lower the prevalence of pancreas-related complications.…”

Course of transplant recipients treated with Ertapenem in the prophylaxis and treatment of infections: a first experience

“…Although many of these infections are well controllable due to rapid detection and highly active antimicrobial agents, some of them remain a challenge and serious risk for the patient. In pancreas recipients postoperative infections are reported to occur in 50-100% [17,18] and in liver recipients in up to 80% [19,20]. Bacterial infections remain a significant source of morbidity and mortality during the early postoperative period [21].…”

Urinary tract infections in renal transplant recipients

“…Improvement in the technical aspects of the surgery and advances in antirejection therapies have resulted in 1-year patient, kidney, and pancreas survival rates of 95% to 98%, 92% to 94%, and 78% to 84%, respectively [41]. However, infection-related morbidity and mortality are common in these patients, in contrast to kidney alone transplant recipients, which can be attributed to the complexity of the surgical techniques, duration of surgery, and structural and metabolic changes that occur in the urinary bladder due to pancreatic secretions [42][43][44][45][46].…”

“…UTIs (38%) were the most common infection followed by bloodstream infections 15% and surgical site infections (9%) [45]. Another retrospective study of 72 pancreas recipients, all of whom received broad-spectrum antibiotics and fluconazole for 7 days and appropriate prophylaxis for cytomegalovirus, reported an infection rate of 46%, the most common being UTI (17%), intra-abdominal infections (17%), bloodstream infections (18%), surgical site infections (10%), and cytomegalovirus infection (10%) [42]. Similar findings have been reported from other studies [43,44].…”