title: Portal versus systemic drainage of small bowel allografts: comparative assessment of survival, function, rejection, and bacterial translocation.
abstract: 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.
authors.affiliation: Liver/Gastrointestinal Transplantation, Department of Surgery, University of Miami School of Medicine, Miami, FL 33136, USA.
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Kato
authors.forename: Seigo
authors.initials: S
authors.lastname: Nishida
authors.forename: A Joseph
authors.initials: AJ
authors.lastname: Tector
authors.forename: Naveen K
authors.initials: NK
authors.lastname: Mittal
authors.forename: Juan
authors.initials: J
authors.lastname: Madariaga
authors.forename: Jose R
authors.initials: JR
authors.lastname: Nery
authors.forename: G Patricia
authors.initials: GP
authors.lastname: Cantwell
authors.forename: Philip
authors.initials: P
authors.lastname: Ruiz
authors.forename: Andreas G
authors.initials: AG
authors.lastname: Tzakis
mesh_terms: 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
chemical_list: D007166:Immunosuppressive Agents