Infection of the pancreatic duct following pancreas transplantation with bladder drainage.

Combined kidney-pancreas transplantation represents a widely accepted therapy for endstage diabetic nephropathy. Drainage of the pancreatic juice into the urinary bladder is the preferred surgical technique in most centers. Between January 1987 and December 1994 a total of 85 pancreas transplantations with pancreatocystostomy were performed at the Innsbruck University Hospital. In all cases a polyvinylcatheter was placed into the pancreatic duct and drained transvesically to the exterior. During several weeks after transplantation pure pancreatic juice was harvested for immunological and microbiological monitoring. Whenever a patient required antibiotic treatment, antibiotic concentrations in pancreatic juice, urine or serum were determined by means of a biological test system using Bacillus subtilis. Nine different ATCC bacterial strains were incubated in pancreatic juice collected from transplant recipients and tested for their multiplication rate. Thirteen patients acquired an infection of the pancreatic duct. Non-fermentative bacteria, gram-negative rods, Enterococcus spp. and Candida spp. were the most often isolated organisms. The in vitro tests revealed that Pseudomonas aeruginosa, Acinetobacter calcoaceticus and Escherichia coli grew very well whereas Streptococcus agalactiae was unable to multiply in pancreatic juice. Ampicillin/sulbactam was found to be excreted in high concentrations into the pancreatic juice. Many other tested antibiotics (cephalosporins, carboxypenicillins and aminoglycosides) achieved levels below the minimum inhibitory concentrations (MICs) for most bacteria. Antibiotic treatment was required for up to 5 weeks to eliminate the pathogens from the pancreas but was successful in 11 out of the 13 patients at the end. The results of this study led to changes in our antibiotic policy and helped to improve the results after pancreatic transplantation.