Association of Bacterial and Fungal Infections With Surgical Complications in Pancreas Transplant Recipients.

670 Purpose: To assess the rate of bacterial and fungal infections in adult pancreas recipients in our institution. Methods: we retrospectively evaluated bacterial and fungal infections in pancreas recipients who underwent transplantion between April 1994 and February 1997. Patient records were retrieved electronically, and infections were tabulated according to conventional definitions. Patients were included if their pancreas graft survival was >72 hours. In case of graft failure patients were followed for 30 days after graft explantation. Results: 132 patients were included in the study, 125 primary and 7 secondary. Immunosuppression included tacrolimus, mycophenolate mofetil, and steroids. The transplant operation was: solitary pancreas (PTA) 8 (6%), pancreas after kidney (PAK) 12 (9%), and simultaneous (SPK) 112 (85%). The pancreas drainage procedure included: enteric 103 (78%), bladder 27 (20.5%), and bladder converted to enteric 2 (1.5%). The mean age was 38 yrs (s.d. ±7), and the male/female ratio was 61/71. Patients were followed for a mean of 690 days (s.d.±415). There were total of 74 infectious episodes (bacterial 62, fungal 6, mixed bacterial/fungal 6) in 51 (38.6%) patients, but only 34 (25.8%) patients had serious infections. They occurred at a median of 18 days (range 1-864) after transplantation. The rate among PTA, PAK, SPK recipients was 75%, 25%, 37.5%, respectively (p=0.06). Fourteen (10.6%) patients developed peritonitis with an equivalent rate among enteric and bladder anastomosis. Twenty-three patients (17.4%) developed deep abdominal abscess with an infection rate among patients with bladder and enteric anastomosis of 18.5% and 15.5%, respectively (p=0.9). Urinary tract infection occurred in 29.6% and 5.8% of patients with bladder and enteric anastomosis, respectively (p=0.0001), and was equivalent among the 3 types of transplant operation. The rate of surgical complications in patients with and without infection was 49% and 3%, respectively (p=0.0001). All 11 patients with bowel fistulas developed infection compared to 33% of patients without fistulas (p=0.0001). The overall mortality was 3% and two deaths were associated with infection. Conclusions: Bacterial and fungal infections are highly associated with surgical complications. Urinary tract infections are more commonly associated with bladder anastomosis, and this may explain the relatively higher rate of infection among solitary pancreas recipients.