Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors Whole-organ pancreas transplants have proven efficacy in establishing normoglycemia and insulin independence in recipients with type 2 diabetes mellitus. Typically, the pancreas allograft is har- vested with a duodenal cuff from a deceased donor. It is then transplanted into the recipient’s perito- Nath DS, Gruessner A, Kandaswamy R, Gruessner RW, Sutherland DER, Humar A. Late anastomotic leaks in pancreas transplant recipients – clinical characteristics and predisposing factors. Clin Transplant 2005: 19: 220–224. ª Blackwell Munksgaard, 2005 Abstract: Background: Anastomotic leaks after pancreas transplants usu- ally occur early in the postoperative course, but may also be seen late post- transplant. We studied such leaks to determine predisposing factors, methods of management, and outcomes. Results: Between January 1, 1994 and December 31, 2002, a total of 25 pancreas transplant recipients at our institution experienced a late leak (defined as one occurring more than 3 months post-transplant). We exclu- ded recipients with an early leak or with a leak seen immediately after an enteric conversion. The mean recipient age was 40.3 yr; mean donor age, 31.3 yr. The category of transplant was as follows: simultaneous pancreas– kidney (n ¼ 5, 20%), pancreas after kidney (n ¼ 10, 40%), and pancreas transplant alone (n ¼ 10, 40%). At the time of their leak, most recipients (n ¼ 23, 92%) had bladder-drained pancreas grafts; only two recipients (8%) had enteric-drained grafts. The mean time from transplant to the late leak was 20.5 months (range ¼ 3.5–74 months). A direct predisposing event or risk factor occurring in the 6 wk preceding leak diagnosis was identified in 10 (40%) of the recipients. Such events or risk factors included a biopsy-proven episode of acute rejection (n ¼ 4, 16%), a history of blunt abdominal trauma (n ¼ 3, 12%), a recent episode of cytomegalovirus infection (n ¼ 2, 8%), and obstructive uropathy from acute prostatitis (n ¼ 1, 4%). Non-operative or conservative care (Foley catheter placement with or without percutaneous abdominal drains) was the initial treatment in 14 (56%) of the recipients. Such care was successful in nine (64%) of the 14 recipients; the other five (36%) required surgical repair after failure of conservative care at a mean of 10 d after Foley catheter placement. Of the 25 recipients, 11 underwent surgery as their initial leak treatment: repair in nine and pancreatectomy because of severe peritonitis in two. After appropriate management (conservative or operative) of the initial leak, five (20%) of the 25 recipients had a recurrent leak; the mean length of time from initial leak to recurrent leak was 5.6 months. All five recipients with a recurrent leak ultimately required surgery. Conclusions: Late anastomotic leaks are not uncommon; they may be more common with bladder-drained grafts. One-third of the recipients with a late leak had experienced some obvious preceding event that predisposed to the leak. For two-thirds of our stable recipients with bladder-drained grafts, non-operative treatment of the leak was successful. Dilip S Nath, Angelika Gruessner, Raja Kandaswamy, Rainer W Gruessner, David ER Sutherland and Abhinav Humar Department of Surgery, University of Minnesota, Minneapolis, MN, USA Key words: anastomotic leaks – pancreas transplants – surgical complications Corresponding author: Abhinav Humar MD, Department of Surgery, University of Minnesota Medical School, MMC 328, 420 Delaware Street S.E., Minneapolis, MN 55455, USA. Tel.: 612-624-0688; fax: 612-624-7168; e-mail: humar001@umn.edu Accepted for publication 3 November 2004 Clin Transplant 2005: 19: 220–224 DOI: 10.1111/j.1399-0012.2005.00322.x Copyright ª Blackwell Munksgaard 2005 220