Pancreas graft loss caused by intra-abdominal infection. A risk factor for a subsequent pancreas retransplantation
E. Benedetti, C. Troppmann, A. C. Gruessner, D. E. Sutherland, D. L. Dunn and W. G. Gruessner
Department of Surgery, University of Minnesota, Minneapolis, USA.
OBJECTIVE: To investigate whether previous pancreas graft loss caused by
intra-abdominal infection is a risk factor for a subsequent pancreas
retransplantation. DESIGN: Retrospective case-series analysis. SETTING:
Large university hospital. PATIENTS: Of 97 pancreatic retransplantations
(July 1, 1985 to June 30, 1994), 13 (13%) were performed after previous
pancreas grafts had been lost because of intra-abdominal infection. MAIN
OUTCOME MEASURES: Cause of retransplant graft loss; patient survival.
RESULTS: Of 13 cases of pancreatic retransplantations performed after
previous grafts had been lost because of intra-abdominal infection, 12
(92%) were again complicated by intra-abdominal infection. Of these 12
retransplantation infections, 10 were caused by the same microbial species
that had caused failure of the previous graft 1 to 5 years earlier (8
required graft pancreatectomy [mortality rate, 25%], and 2 were
successfully treated) and 2 were caused by different microbial species
(both required graft pancreatectomy [mortality rate, 0%]). In 1 of the 13
retransplantations, prophylactic antimicrobial treatment was directed at
the microbial species that had caused failure of the previous graft; no
recurrent intra-abdominal infection developed. CONCLUSIONS: Intra-abdominal
infection after a previous pancreas transplantation is a risk factor for
recurrence of infection by the same microbial species after a subsequent
retransplantation. For the selected patients who are considered for
retransplantation in spite of their previous graft loss caused by
intra-abdominal infection, periretransplantation antimicrobial prophylaxis
should include a prolonged course of an agent directed against the
previously identified microbial species.