A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation.
BACKGROUND
Most pancreas transplants are performed with systemic venous delivery of insulin and bladder drainage of the exocrine secretions (systemic-bladder [S-B]). To develop a more physiologic procedure, we performed pancreas transplantations with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric [P-E]).


METHODS
During an 11-month period, we prospectively alternated 32 consecutive pancreas transplant recipients to either S-B (n = 16) or P-E (n = 16) drainage with standardized immunosuppression.


RESULTS
Patient, kidney, and pancreas graft survival rates after simultaneous kidney-pancreas transplantation were 91% S-B versus 92% P-E, 91% S-B versus 92% P-E, and 82% S-B versus 92% P-E, respectively. Pancreas graft survival rates after solitary pancreas transplantation were 80% S-B versus 75% P-E. There were no graft losses either to immunologic or infectious complications in either group, but the incidence of acute rejection was slightly higher in the S-B group (44% S-B vs 31% P-E, P = NS). The cost and length of the initial hospital stay were similar between groups. The incidence of operative complications, major infections, and cytomegalovirus infections were likewise comparable. However, the S-B group was characterized by a slight increase in the number of readmissions, urinary tract infections, and urologic complications. Furthermore, metabolic acidosis and dehydration were more common in the S-B group.


CONCLUSIONS
Pancreas transplantation with P-E drainage can be performed with short-term results comparable to those of transplantation with S-B drainage.
Stratta
R J
RJ
Department of Surgery, University of Tennessee, Memphis, USA.
Gaber
A O
AO
Shokouh-Amiri
M H
MH
Reddy
K S
KS
Egidi
M F
MF
Grewal
H P
HP
Gaber
L W
LW
D000328:Adult; D000714:Anastomosis, Surgical; D003920:Diabetes Mellitus / Q000601:surgery; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007083:Iliac Artery / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery*; D016030:Kidney Transplantation; D007902:Length of Stay; D008297:Male; D008642:Mesenteric Veins / Q000601:surgery; D010179:Pancreas / Q000601:surgery; D016035:Pancreas Transplantation / Q000379:methods*; D011169:Portal Vein / Q000601:surgery*; D011183:Postoperative Complications; D011446:Prospective Studies; D001743:Urinary Bladder / Q000601:surgery*