title: Enteric drainage of a pancreas allograft is safe for patients with celiac sprue.
abstract: Enteric drainage of exocrine secretions in whole organ pancreas transplantation is generally avoided in patients with pre-existing small bowel disease; however, bladder drainage is associated with a 20% rate of urinary tract-related complications. This is a case report of a type 1 diabetic patient with celiac sprue and renal failure. We performed a simultaneous cadaveric kidney pancreas transplant enterically draining the exocrine pancreas. There were no complications. The patient is now more than 6 months post-transplant with excellent function of both renal and pancreas allografts. We conclude that enteric drainage of pancreas allografts in patients with celiac sprue may be performed safely. Whole organ pancreas transplantation is being performed with greater success than ever before, mostly as a result of lessons learned from past experience (1). Enteric drainage of allograft exocrine secretions is preferred for simultaneous pancreas/kidney (SPK) recipients to avoid urinary tract complications associated with bladder drainage. However, most agree that diabetics with pre-existing bowel disease should have bladder drainage of allograft exocrine secretions, so as to prevent the devastating complication of a bowel leak. We describe here a successful case of enteric drainage of an SPK transplant in a patient with celiac sprue. We believe that, when carefully performed, enteric drainage of pancreas allografts is a safe approach for diabetic patients with celiac sprue, and may avert the serious complications associated with bladder drainage.
authors.affiliation: Department of Surgery, Division of Transplantation, The Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Akoad
authors.forename: Mauricio
authors.initials: M
authors.lastname: Giraldo
authors.forename: Anthony P
authors.initials: AP
authors.lastname: Monaco
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Hanto
authors.forename: Marc E
authors.initials: ME
authors.lastname: Uknis
mesh_terms: D000328:Adult; D000714:Anastomosis, Surgical; D002446:Celiac Disease / Q000150:complications*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000601:surgery*; D004322:Drainage; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D016035:Pancreas Transplantation; D014184:Transplantation, Homologous