Document Detail


Intra-abdominal fungal infections after pancreatic transplantation: incidence, treatment, and outcome.
MedLine Citation:
PMID:  8843258     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Intra-abdominal infections account for 15 percent of technical failures after pancreatic transplantation. Although some data are available about intra-abdominal bacterial infections, no study has analyzed the incidence, treatment, and outcome of intra-abdominal fungal infections. STUDY DESIGN: We retrospectively studied 445 consecutive pancreatic transplantations--45 percent were simultaneous pancreatic and renal, 24 percent pancreatic after renal, and 31 percent pancreatic transplantations alone--in patients with Type I diabetes mellitus. Donors were cadavers in 92 percent and living relatives in 8 percent. Primary transplantations were done in 80 percent and retransplantation in 20 percent. Of these 445 pancreatic transplantations, 90 percent were bladder-drained, 9 percent enteric-drained, and 1 percent duct-injected. Only symptomatic patients with documented culture-positive intra-abdominal fungal infections were included. RESULTS: Intra-abdominal fungal infections occurred after pancreatic transplantation in 41 (9.2 percent) of 445 patients. Donor age, but not recipient age, was a significant risk factor. The rate of infections was higher for enteric-drained (21 percent) than for bladder-drained (10 percent) transplantations; for organs donated by living relatives (16 percent) than for those from cadavers (9 percent); and for pancreatic after renal (12 percent) and simultaneous pancreatic-renal (11 percent) than for pancreatic-only (5 percent) recipients. The rate of intra-abdominal fungal infections was 6 percent for recipients who were given antifungal prophylaxis (fluconazole, 400 mg/day for seven days after transplantation) compared with 10 percent for those without prophylaxis. The one-year graft survival rate for recipients with infection was 17 percent compared with 65 percent for those without (p = 0.0001); the survival rate was 70 percent compared with 92 percent for patients with and without infection, respectively (p = 0.0007). In 22 percent of recipients, the infection resolved and graft function persisted; in 58 percent, the infection resolved after transplant pancreatectomy; and in 20 percent, death occurred despite transplant pancreatectomy. Recipients with sole fungal or fungal and bacterial infection (n = 41) were 50 percent less likely to recover with a functioning graft and had a risk of death that was three times higher (p < or = 0.05) than those with sole bacterial infection (n = 48). CONCLUSIONS: Intra-abdominal fungal infections after pancreatic transplants are associated with high morbidity and mortality rates, significantly higher than for sole bacterial infections. In addition to aggressive treatment, including transplant pancreatectomy and reduction of immunosuppression, efforts must be made toward better prevention of intra-abdominal fungal infections.
Authors:
E Benedetti; A C Gruessner; C Troppmann; B E Papalois; D E Sutherland; D L Dunn; R W Gruessner
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of the American College of Surgeons     Volume:  183     ISSN:  1072-7515     ISO Abbreviation:  J. Am. Coll. Surg.     Publication Date:  1996 Oct 
Date Detail:
Created Date:  1996-11-13     Completed Date:  1996-11-13     Revised Date:  2009-11-19    
Medline Journal Info:
Nlm Unique ID:  9431305     Medline TA:  J Am Coll Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  307-16     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, University of Minnesota Hospital, Minneapolis 55455, USA.
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MeSH Terms
Descriptor/Qualifier:
Adult
Age Factors
Amphotericin B / therapeutic use
Antifungal Agents / therapeutic use
Bacterial Infections / epidemiology
Candidiasis / epidemiology*,  therapy
Diabetes Mellitus, Type 1 / surgery
Female
Fluconazole / therapeutic use
Graft Survival
Humans
Immunosuppressive Agents / therapeutic use
Incidence
Kidney Transplantation
Male
Pancreas Transplantation*
Postoperative Complications / epidemiology*,  therapy
Reoperation
Retrospective Studies
Risk Factors
Tissue Donors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Antifungal Agents; 0/Immunosuppressive Agents; 1397-89-3/Amphotericin B; 86386-73-4/Fluconazole
Comments/Corrections
Comment In:
J Am Coll Surg. 1996 Oct;183(4):408-10   [PMID:  8843273 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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