Portal versus systemic drainage of small bowel allografts: comparative assessment of survival, function, rejection, and bacterial translocation.
BACKGROUND
Portal venous drainage of small bowel grafts is theoretically more physiologic than systemic drainage, but is technically more demanding. Comparisons in animal models have not demonstrated a clear advantage of one technique over the other, but clinical data are lacking.


METHODS
Clinical records of 36 patients who underwent 37 small bowel transplantation procedures from January 1995 to August 2001 were reviewed. Portal drainage was performed in 19 patients (PD group). Systemic drainage was performed in 18 patients (SD group). Median followup was 531 days.


RESULTS
PD and SD patients had similar ICU stays (median 7 versus 9 days) and endotracheal intubation durations (median 3 versus 5 days). All current survivors, with the exception of one patient in each group, are independent from parenteral nutrition. Liver function tests were similar in both groups. There was a twofold increase in tacrolimus dosage in the PD group to achieve similar trough levels indicating a "first-pass" hepatic clearance effect. Cumulative incidence of acute rejection episodes and OKT3-requiring rejection episodes were similar in both groups. To the contrary, a lower incidence of gram-negative rods of Enterococcus sp. in blood or bronchoalveolar lavage suggested that the clearance of translocated intestinal bacteria was more efficient in the PD group. Graft and patient survival rates were similar in both groups.


CONCLUSIONS
Systemic venous drainage of small bowel transplants is a dependable technique, associated with similar results as portal venous drainage, in terms of overall mortality, morbidity, rejection, function, and patient and graft survival. But attention should be paid to an impaired clearance of intestinal bacterial translocation after systemic drainage.
Berney
Thierry
T
Liver/Gastrointestinal Transplantation, Department of Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
Kato
Tomoaki
T
Nishida
Seigo
S
Tector
A Joseph
AJ
Mittal
Naveen K
NK
Madariaga
Juan
J
Nery
Jose R
JR
Cantwell
G Patricia
GP
Ruiz
Philip
P
Tzakis
Andreas G
AG
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001424:Bacterial Infections / Q000382:microbiology; D018988:Bacterial Translocation; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007421:Intestine, Small / Q000098:blood supply* / Q000637:transplantation*; D008111:Liver Function Tests; D008297:Male; D011169:Portal Vein; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
D007166:Immunosuppressive Agents