Clinically Significant Peripancreatic Fluid Collections After Simultaneous Pancreas-Kidney Transplantation Rajinder Pal Singh, Georgios Vrakas, Samiha Hayek, Sara Hayek, Sadia Anam, Mariam Aqueel, Jonathon Olsburgh, Francis Calder, Nizam Mamode, Christopher Callaghan, Nicos Kessaris, James Pattison, Rachel Hilton, Geoff Koffman, John D. Taylor, and Martin W. Drage Background. Peripancreatic fluid collections (PPFC) are a serious complication after simultaneous pancreas-kidney transplantation (SPKTx). Methods. Retrospective study for all 223 SPKTx performed from December 8, 1996, to October 10, 2011, to evaluate the risk factors (RF) and impact of PPFCs on outcomes was conducted. Results. Clinically significant PPFCs were seen in 36 (16%) cases, all within 3 months after transplantation. Radio- logic drainage resolved 2 (6%) cases, and 34 required laparotomy (mean [SD], 4 [7]). Compared with the non-PPFC group (n=186), the PPFC group had similar patient and total kidney graft survivals but significantly lower total pancreas survival (68% vs. 85%) and greater incidence of infections (75% vs. 46%, all PG0.05) at 5 years. PPFCs were associated with early graft pancreatitis in 18 (50%), pancreatic fistula in 20 (56%, 9 with obvious duodenal stump leak) and infection in the collection in 20 (56%) cases. Comparison of PPFCs with pancreas graft loss to the PPFCs with surviving grafts showed that the incidence of pancreatic fistula was greater in the former (90% pancreas graft loss vs. 42% pancreas graft survival, PG0.01). Binary logistic regression analysis of RF for developing PPFC showed a donor age 930 years to be significant (P=0.03; odds ratio, 3.4; confidence interval, 1.1Y10.5) and a trend of association with donor body mass index 930 and pancreas cold ischemia time greater than 12 hr. Conclusions. PPFCs are associated with significant reduction in pancreas allograft survival and impact resource use. Donor age 930 years is a significant RF for their development. PPFCs associated with pancreatic fistula carry a greater risk for pancreas graft loss. Keywords: Pancreas, Transplantation, Complications. (Transplantation 2013;00: 00Y00) T he success of pancreas transplantation has grown com- mensurate with improvement in the donor selection criteria, refinement in technical skills, management of im- munosuppression, postoperative care and, most impor- tantly, based on the lessons learned from past experience (1). Implantation of kidney-pancreas is not only life lengthening but also a quality-improving procedure (2, 3) in uremic diabetics. Technical factors still reign supreme as the major causes of early graft loss (4, 5), but the focus and impetus placed on reducing their rates have met with considerable success. Although ‘‘success,’’ when measured in terms of pure graft survival, may have improved, those causing prolonged morbidity still remain relatively less well addressed. Fore- most among these causes are peripancreatic fluid collections (PPFCs) (6), a serious morbidity familiar to pancreas trans- plantation surgeons, and a troublesome complication that can be unnerving for both the patient and health care per- sonnel. It is a common cause for return to the operating the- ater for ‘‘wash-outs,’’ which are sometimes quite frequent and entail immense resource use. This is in stark contrast to those cases that do well, have no such complications, have a shorter postoperative stay, and therefore have the most gratifying re- sults. It is unclear if there are any predisposing factors that are associated with their development. Most of the literature on PPFC is more than a decade ago (6, 7), and it is unclear as to where we stand today in terms of this outcome. Also, to the best of our knowledge, there is no study focusing on the risk factors leading to this complication. The purpose of our study was to delve deeper into this important but less well-addressed subject by assessing the impact of PPFCs on the outcomes of simultaneous pancreas-kidney transplantation (SPKTx) and CLINICAL AND TRANSLATIONAL RESEARCH Transplantation & Volume 00, Number 00, Month, 2013 www.transplantjournal.com 1 The authors declare no funding or conflicts of interest. Department of Transplant Surgery, MRC Centre for Transplantation, Guy’s Hospital, Great Maze Pond, London, United Kingdom. Address correspondence to: Rajinder Pal Singh, M.B.B.S., M.S., M.R.C.S., Renal and Transplant Division, 6th Flr, Renal Offices, Borrough Wing, Guy’s and St Thomas’ Hospital, London SE1 9RT, United Kingdom. E-mail: rpss27@yahoo.co.uk R.P.S., G.K., J.D.T., and M.W.D. participated in making the research design, in writing the paper, in performing the research, and in analyzing the data. J.O. participated in writing the paper and in performing the re- search. F.C., N.M., C.C., N.K., J.P., and R.H. participated in performing the research. G.V., Sam.H., Sar.H., M.A., and S.A. participated in performing the research and in analyzing the data. Received 17 July 2012. Revision requested 3 August 2012. Accepted 24 January 2013. Copyright * 2013 by Lippincott Williams & Wilkins ISSN: 0041-1337/13/0000-00 DOI: 10.1097/TP.0b013e318289c978 Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.