Long-term follow-up study of necrotising pancreatitis: interventions, complications and quality of life.

OBJECTIVE: To describe the long-term consequences of necrotising pancreatitis, including complications, the need for interventions and the quality of life. DESIGN: Long-term follow-up of a prospective multicentre cohort of 373 necrotising pancreatitis patients (2005-2008) was performed. Patients were prospectively evaluated and received questionnaires. Readmissions (ie, for recurrent or chronic pancreatitis), interventions, pancreatic insufficiency and quality of life were compared between initial treatment groups: conservative, endoscopic/percutaneous drainage alone and necrosectomy. Associations of patient and disease characteristics during index admission with outcomes during follow-up were assessed. RESULTS: During a median follow-up of 13.5 years (range 12-15.5 years), 97/373 patients (26%) were readmitted for recurrent pancreatitis. Endoscopic or percutaneous drainage was performed in 47/373 patients (13%), of whom 21/47 patients (45%) were initially treated conservatively. Pancreatic necrosectomy or pancreatic surgery was performed in 31/373 patients (8%), without differences between treatment groups. Endocrine insufficiency (126/373 patients; 34%) and exocrine insufficiency (90/373 patients; 38%), developed less often following conservative treatment (p<0.001 and p=0.016, respectively). Quality of life scores did not differ between groups. Pancreatic gland necrosis >50% during initial admission was associated with percutaneous/endoscopic drainage (OR 4.3 (95% CI 1.5 to 12.2)), pancreatic surgery (OR 3.2 (95% CI 1.1 to 9.5) and development of endocrine insufficiency (OR13.1 (95% CI 5.3 to 32.0) and exocrine insufficiency (OR6.1 (95% CI 2.4 to 15.5) during follow-up. CONCLUSION: Acute necrotising pancreatitis carries a substantial disease burden during long-term follow-up in terms of recurrent disease, the necessity for interventions and development of pancreatic insufficiency, even when treated conservatively during the index admission. Extensive (>50%) pancreatic parenchymal necrosis seems to be an important predictor of interventions and complications during follow-up.

Chronic Inguinal Pain After Kidney Transplantation, a Common and Underexposed Problem.

BACKGROUND: The incidence and impact of chronic inguinal pain after kidney transplantation is not clearly established. A high incidence of pain after inguinal hernia repair, a comparable surgical procedure, suggests an underexposed problem. METHODS: Between 2011 and 2013, 403 consecutive patients who underwent kidney transplantation were invited to complete the Caroline Comfort Scale (CCS) and Visual Analog Scale (VAS) in order to assess the incidence of chronic inguinal pain and movement disabilities, complemented by questions regarding comorbidity during follow-up. RESULTS: The response rate was 58 % (n = 199) with a median follow-up of 22 months (IQR 12-30). In total, 90 patients (45 %) reported a CCS > 0 and 64 patients (32 %) experienced at least mild but bothersome complaints. Most inguinal complaints were reported during bending over and walking with a mean CCS score of 1.1 (SD ± 2.2) and 1.2 (SD ± 2.4), respectively. A high body mass index (BMI), delayed graft function, and the need for a second operation were associated with a higher CCS score on univariate analysis. Using multivariate analysis, only BMI (p = 0.02) was considered an independent risk factor for chronic inguinal pain. CONCLUSIONS: The incidence of chronic inguinal pain is a common though underexposed complication after kidney transplantation. More awareness to prevent neuropathic pain seems indicated.

Multiple Renal Arteries in Kidney Transplantation: A Systematic Review and Meta-Analysis.

BACKGROUND: The use of grafts with multiple renal arteries (MRA) in renal transplantation has not been clearly established. MATERIAL/METHODS: A systematic literature review used predefined terms to search PubMed, EMBASE, and the Cochrane Library for all studies since 1985 that included more than 50 MRA grafts. A total of 23 studies, comprising a total of 18,289 patients, were eligible to be included in the meta-analysis. RESULTS: Patients who received an MRA graft compared to single renal artery (SRA) grafts showed significantly higher complication rates (13.8% vs. 11.0%, OR 1.393, p<0.0001), more delayed graft function (10.3% vs. 8.2%, OR 1.333, p=0.022), and had an associated significantly lower 1-year graft survival (93.2% vs. 94.5%, OR 0.819, p=0.034). Both the creatinine level and the warm ischemia time (WIT) were significantly higher in patients with MRA grafts but showed high heterogeneity (I² 98% for WIT and I² 70% for creatinine level). Although MRA grafts were associated with more complications compared to SRA grafts, long-term outcomes were similar for 5-year graft survival (81.4% vs. 81.6%) and 1- and 5-year patient survival (95.4% and 89.6% in MRA group vs. 95.4% and 87.0% in SRA group, respectively). CONCLUSIONS: MRA grafts were associated with a higher risk of complication and delayed graft function but had comparable long-term outcomes for graft and patient survival.