Late recurrent bleeding episodes from duodenojejunostomy after pancreas transplantation

Abstract

In response to a number of late, repetitive bleeding episodes from the site of the enteric anastomosis, we herein analyze the clinical courses and etiologies of 379 consecutively performed pancreas transplants between January 2000 and December 2016. Duodenojejunostomies for enteric drainage were performed at the upper jejunum in a side to side, double layer fashion. Five patients (1.3%) developed recurrent late hemorrhagic episodes originating from the graft duodenal anastomosis. Bleeding from the anastomotic site was associated with hematochezia, hemodynamic instability and decrease in serum hemoglobin. Mean onset was 6.4(±2.8) years after transplantation. Bleeding was recurrent (mean 5.2 ± 2.6) and required 9(±2.5) interventions. Hypervascularization, mucosal vulnerability, and bleeding at the site of the enteric anastomosis could be identified in all cases. In four patients, the enteric pancreas anastomosis was resected and a new duodenojejunostomy was performed. No pancreas graft loss occurred due to bleeding. In two patients, hepatic cirrhosis and portal hypertension were identified, one patient had a liver fibrosis as putative cause for the repetitive bleeding episodes. Late anastomotic hemorrhage is a rare but severe complication following pancreas transplantation. The treatment is challenging and includes endoscopy, interventional radiology, and surgery. Hepatic conditions with an increased portal pressure may be the underlying cause.

Donor cardiac arrest and cardiopulmonary resuscitation: impact on outcomes after simultaneous pancreas–kidney transplantation – a retrospective study

“…The SPK transplantations were carried out according to standard techniques as previously published . Full‐size pancreas grafts were procured in a no‐touch technique after perfusion with University of Wisconsin or histidine–tryptophan–ketoglutarate solution.…”

Intraoperative reperfusion assessment of human pancreas allografts using hyperspectral imaging (HSI)

“…This scanner is [1] and focused to the entrance slit [2] of the spectrograph. A disperse device [3][4][5] inside the spectrograph, consisting of special lenses [3 and 5] and a transmission grating [4] splits the light into several beams depending on the wavelength. Finally, an image sensor [6] for digital processing captures these beams.…”

“…While outcomes have continued to improve, pancreas transplantation is still associated with significant potential morbidity and mortality (1). The incidence of anastomosis site leakage after pancreatic transplantation ranges from 5% to 8% and is related to technical problems, such as impaired blood supply and ischemia of the graft (2,3). Adequate oxygen delivery at the tissue level is critical for maintaining graft viability and promoting aerobic metabolism.…”

“…The reflected light from the tissue is captured by the objective lens[1] and focused to the entrance slit[2] of the spectrograph. A disperse device[3][4][5] inside the spectrograph, consisting…”

Recipient age and outcome after pancreas transplantation: a retrospective dual‐center analysis

“…Simultaneous pancreas kidney (SPK), pancreas after kidney (PAK), or pancreas transplant alone (PTA) transplantations were carried out according to standard techniques as published before [17][18][19][20] Full-size pancreas grafts were procured in a no-touch technique after perfusion with University of Wisconsin (UW) or histidine-tryptophan-ketoglutarate (HTK) solution. Briefly, the renal artery and vein were anastomosed to the left external iliac vessels; the pancreas graft was transplanted intraperitoneally into the right middle to lower quadrant.…”