Laparoscopic biopsies in pancreas transplantation

UVA P; PETRONI J; CABRERA I; GIUNIPPERO A; ARROSAGARAY V; LEON L; GONZALEZ A; BUONPENSIERE M; GALLO A; CASADEI D

San Francisco

Congreso; World Transplant Congress 2014. XXV International Meeting of TTS; 2014

The Transplantation Society - TTS

In pancreas transplantation there is no reliable laboratory test or imaging study for detection of graft rejection. Pancreas biopsies were attempted percutaneously, transcystoscopic, laparoscopic or by open laparotomy. We describe our series of 66 laparoscopic biopsies in pancreas transplant patients over the past two years. Methods: This is a retrospective review of a prospectively collected database. We evaluated reason for biopsy, yield of tissue samples, need of conversion to open surgery and postoperative complications. Operative technique: A Foley catheter was placed in site. Carbon dioxide was used through an Optiview port placed in the left upper quadrant. Two 5mm trocars were placed in the right upper quadrant and in the midline incision below the umbilicus. The kidney biopsy was performed by a core biopsy needle (16G) under direct visualization and hemostasis performed by compression and cautery. Then the tail of the pancreas was dissected and a biopsy was performed using scissors and cautery. After surgery a weight was positioned over the kidney to provide compression for a few hours. Results: From October 2011 to December 2013 we have attempted 66 pancreas biopsies in 43 patients with either simultaneous pancreas kidney (SPK) or pancreas alone transplant patients (38 and 5 cases). In 9 opportunities only pancreas biopsy was attempted because of PTA (7 cases) or kidney loss in SPK (2 cases). In one case the abdomen could not be distended due to extensive adhesions of the viscerae in a patient with history of peritoneal dialysis and a percutaneous kidney biopsy was performed at a later moment. In the rest of the kidney biopsy attempts, tissue was obtained for proper diagnosis representing a yield of 98.2% (56 of 57 cases). On the pancreas yield, 2 other patients (besides the previously described one) had adhesions that did not allow reaching the pancreas, and in one case the pancreas biopsy was not done because of a lasceration of the duodenum. Pancreas was visualized and tissue was obtained in 62 cases. Of these, 4 samples were classified as adipose tissue and the rest were pancreas tissue that allowed a pathologic diagnosis representing a yield of 87.9% (58 of 66 cases). There was a need for a small laparotomy in 4 cases. One to oversaw the duodenum lasceration, one to reach the kidney behind strong bowel adhesions and two for kidney hemostasis in the same patient with a severe humoral rejection. Postoperative complications included one patient with hematuria requiring a three way Foley catheter with Saline infusion and one relaparoscopy to drain a hematoma due to bleeding of a trocar site. No graft was lost due to a biopsy procedure complication. Conclusions: Laparoscopic biopsies of both grafts can be performed with safety in patients after pancreas transplantation with a yield comparable to other techniques and with an acceptable morbidity.