USA Technical Failure

Technical failure (TF) rates for 1996-2000 US cadaver pancreas transplants were significantly lower for BD versus ED cases (Table 1a). TF rates for ED pancreas transplants did not significantly differ with or without the use of the Roux-en-Y loop of recipient bowel (Table 1b), except within the portal venous drainage group, where TF was higher without a Roux-en-Y. Technical failure rates have decreased significantly over time for 1987-2000 US cadaver pancreas transplants, from 15% for 1987-89 to 7% for the 1998-2000. In all categories, TF rate has declined in each era since 1990; earlier TF rates for PAK and PTA groups may have been higher due to early rejections being reported as technical.

Table 1a

Table 1b

Graft thrombosis was the most common cause of TF for 1996-2000 US cadaveric pancreas transplant cases, > 70%, whether by duct management (BD, ED) or transplant category (SPK, PAK, PTA). The incidence of any one of the remaining TF reasons - infection/pancreatitis, anastomotic leak, bleed - was <3% in each transplant category. For PAK and PTA categories, the graft thrombosis and anastomotic leak rates were lower for BD versus ED (Table 2). For ED in the PTA group, some early thrombosis may actually be early rejection since the diagnosis of early rejection is more difficult in the ED PTA group.

Table 2