TY - JOUR
T1 - Nonmarginal-donor duodenal ulcers caused by rejection after simultaneous pancreas and kidney transplantation
T2 - A case report
AU - Miyagi, S.
AU - Sekiguchi, S.
AU - Kawagishi, N.
AU - Akamatsu, Y.
AU - Satoh, K.
AU - Takeda, I.
AU - Fujimori, K.
AU - Satomi, S.
N1 - Funding Information:
Supported by grants-in-Aid for Scientific Research from the Ministry of Education, Science, and Culture of Japan and the Ministry of Welfare of Japan and by a grant from Tohoku University Graduate School of Medicine .
PY - 2011/11
Y1 - 2011/11
N2 - Objective: Pancreas transplantation has been associated with the highest surgical complication rate among routinely performed organ transplant procedures. Complications can be caused not only from the pancreas itself but also from the simultaneously transplanted duodenum: gastrointestinal bleeding, duodenal ulcer, pseudoaneurysm, arterioenteric fistula, and severe rejection. Herein we report a patient who underwent simultaneous pancreas-kidney transplantation (SPKT) and experienced a duodenal perforation because of rejection. Methods: The 60-year-old man with insulin-dependent diabetes underwent SPKT with enteric drainage. At 15 days there after he displayed melena. Results: We suspected it to be caused by rejection and ischemic changes. We slightly increased the doses, of tacrolimus and methylprednisolone. But 17 days after SPKT, the ulcer perforated, requiring a repair operation and increased dose of mycophenolate mofetil. However, the ulcers perforated repeatedly, requiring 4 repair operations. Unfortunately the patient developed pneumonia that mitigated continues repairs or rejection therapies, so we expated the duodenum and pancreas but saved the kidney. The pathologic findings showed the ulcer to have been caused by severe rejection. Despite those episodes, the patient was weaned from hemodialysis. Conclusions: Perforation of the transplanted duodenum is one of the most difficult complications among SPKT patients. This potentially lethal complication may be caused by mucosal rejection, ischemic changes, and the exocrine output from the pancreatic graft.
AB - Objective: Pancreas transplantation has been associated with the highest surgical complication rate among routinely performed organ transplant procedures. Complications can be caused not only from the pancreas itself but also from the simultaneously transplanted duodenum: gastrointestinal bleeding, duodenal ulcer, pseudoaneurysm, arterioenteric fistula, and severe rejection. Herein we report a patient who underwent simultaneous pancreas-kidney transplantation (SPKT) and experienced a duodenal perforation because of rejection. Methods: The 60-year-old man with insulin-dependent diabetes underwent SPKT with enteric drainage. At 15 days there after he displayed melena. Results: We suspected it to be caused by rejection and ischemic changes. We slightly increased the doses, of tacrolimus and methylprednisolone. But 17 days after SPKT, the ulcer perforated, requiring a repair operation and increased dose of mycophenolate mofetil. However, the ulcers perforated repeatedly, requiring 4 repair operations. Unfortunately the patient developed pneumonia that mitigated continues repairs or rejection therapies, so we expated the duodenum and pancreas but saved the kidney. The pathologic findings showed the ulcer to have been caused by severe rejection. Despite those episodes, the patient was weaned from hemodialysis. Conclusions: Perforation of the transplanted duodenum is one of the most difficult complications among SPKT patients. This potentially lethal complication may be caused by mucosal rejection, ischemic changes, and the exocrine output from the pancreatic graft.
UR - http://www.scopus.com/inward/record.url?scp=81455142525&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=81455142525&partnerID=8YFLogxK
U2 - 10.1016/j.transproceed.2011.09.094
DO - 10.1016/j.transproceed.2011.09.094
M3 - Article
C2 - 22099780
AN - SCOPUS:81455142525
VL - 43
SP - 3292
EP - 3295
JO - Transplantation Proceedings
JF - Transplantation Proceedings
SN - 0041-1345
IS - 9
ER -