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Endoscopic visualization of graft status in patients with pancreas transplantation

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Abstract

Background

Enteric drainage into the recipient duodenum in pancreas transplantation (PT) can identify the graft duodenum by endoscopy. This study aimed to identify the characteristic endoscopic findings associated with graft failure or acute rejection in patients with PT.

Methods

We reviewed the medical records of patients who underwent PT with duodenoduodenostomy (DD) between January 2015 and August 2019. During this period, there were 44 PTs with DD in 42 patients; 122 endoscopies were performed and analyzed.

Results

Overall, pancreatic graft survival was 82% at a mean follow-up of 27 months (range 6–55 months). There were 8 graft failures and 10 acute rejections. In all 8 graft failures, a deep ulcer covered with fibrinous exudates of the graft duodenum was confirmed on endoscopy. Diffuse erythema inside the graft duodenum was observed in 8 of 10 acute rejections. The factors associated with acute rejection were elevated serum lipase level (OR 8.5, p = 0.02) and diffuse erythema inside the graft duodenum on endoscopy (OR 20.5, p < 0.01) in multivariate analysis.

Conclusions

In PT with DD patients, graft failure can be visualized by endoscopy, and diffuse erythema inside the graft duodenum may be a finding of acute rejection.

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Authors and Affiliations

  1. Department of Internal Medicine, Medical Research Institute, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Beomeo-ri Mulgeum-eup, Yangsan-si, Gyeongsangnam-do, Yangsan, 50612, Korea

    Dae Gon Ryu, Dae Hwan Kang, Cheol Woong Choi, Hyung Wook Kim, Su Bum Park, Su Jin Kim & Hyeong Seok Nam

  2. Department of Surgery, Pusan National University School of Medicine and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea

    Byung Hyun Choi

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  1. Dae Gon Ryu
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Correspondence to Dae Hwan Kang.

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Disclosures

Dae Gon Ryu, Dae Hwan. Kang, Cheol Woong Choi, Byung Hyun Choi, Hyung Wook Kim, Su Bum Park, Su Jin Kim, and Hyeong Seok Nam have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was approved by the ethics review board of the Pusan National University Yangsan Hospital (Institutional Review Board No. 05-2020-022). The study was conducted in accordance with the principles of the Declaration of Helsinki.

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Informed consent was waived because the subject’s medical records were anonymized prior to analysis.

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Ryu, D.G., Kang, D.H., Choi, C.W. et al. Endoscopic visualization of graft status in patients with pancreas transplantation. Surg Endosc 36, 4057–4066 (2022). https://doi.org/10.1007/s00464-021-08727-0

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  • DOI: https://doi.org/10.1007/s00464-021-08727-0

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