(CS-001) Tisseel ® Fibrin Sealant for management of Pancreatic fistula post simultaneous pancreas kidney transplantation

tai Wei, MD – Transplant Sugery Fellow, Transplant Surgery, Loma Linda University School of Medicine; Nguyen Minh-Tri, MD – Asst Professor of Transplant Surgery, Transplant Surgery, Loma Linda University School of Medicine; Rafale Villicana, MD – Director of Kidney -Pancreas Transplant, Transplant Institute, Loma Linda University; Charles Bratton, MD – Director of kidney Pancreas Transplantation, Transplant Surgery, Masters of Medicine

Introduction:

Background: fibrin sealant (Tissucol/Tisseel Baxter AG, Vienna, Austria) has been used for hemostasis and as a sealant at both anastomotic and non-anastomotic sites. We report the first successful use of fibrin sealant at the non-anastomotic sites on the body of the pancreas allograft to manage pancreatic fistula post SPK. 

Methods: Case Study: observational type.

Results:

We report a 32-year-old Type 1 diabetic patient with renal failure who underwent a simultaneous pancreas kidney transplant. On postoperative day 4, he had leak suspected to be from the graft duodenal stump for which a tube duodenostomy and therefore anastomotic revision was done. He had persistence of the high output pancreatic fistula despite multiple take backs to the operating room to bolster the leak with sutures. Finally, Tisseel ® fibrin sealant was diffusely sprayed over the allograft and the operating field. Following the procedure, the drainage volume decreased from greater than one liter to 90ml per day. The patient was discharged with the drain in place to allow slow healing of the fistula. The patient was doing well. Serum amylase and lipase were within normal limits throughout the hospital stay. The blood glucose was normal, and the patient did not require exogenous insulin. Kidney allograft functioned normally with serum creatinine of 0.9mg/dL.

 

Discussion: High output duodenal fistulas after pancreas transplant surgery are uncommon and rare after redo repair. Pancreas is a fragile organ with a thin and loose capsule therefore prone to subtle injury during handling of the organ.  Tisseel ®) forms a fibrin capsule around the pancreas thereby containing the leak. In our case, fibrin sealant allowed oral feeding to begin, and the patient was discharged home in a timely manner. Thus, need for long term hospitalization and complications of parenteral nutrition were avoided.  

Conclusion: Fibrin gel products are additional options to for conservative management of post pancreas transplant leaks; in particular when there is no evidence of focal anatomical leak point.  

Trademarked Items: Tisseel (R) Fibrin Sealant.

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