Outcomes with the selective use of enteric exocrine drainage in pancreas transplantation.
BACKGROUND
Bladder drainage of the exocrine secretions of pancreas transplants has been the standard of practice as it affords the ability to monitor for rejection and is thought to be associated with decreased morbidity. Recently, there has been renewed interest in avoiding the urinary tract complications and metabolic derangements that accompany bladder drainage by draining pancreatic exocrine secretions into the jejunum (enteric drainage). We sought to determine whether enteric drainage of pancreas transplants is safe and offers advantages without compromise in graft function or longevity.


METHODS
We retrospectively reviewed all pancreas transplants performed at the University of Washington between 2000 and 2003. Selection of the exocrine drainage method was based on the length of cold ischemia time and whether the pancreas was transplanted alone or in combination with a kidney. Pearson's chi-square and Fisher's Exact tests were used for statistical comparisons in complications or rejections between the groups.


RESULTS
Thirty-four pancreas transplants were performed with exocrine drainage into the bladder used in 17 and enteric drainage in 17. The complication rate was 53% in the bladder-drained group and 41% (P=.49) in the enteric-drained group. The incidence of pancreas rejection was 24% in the bladder-drained versus 29% in the enteric-drained patients (P=.50). One graft failed, which was in the bladder cohort.


CONCLUSIONS
We found comparable rejection and complication rates between groups. We conclude that enteric drainage is safe when used selectively, and entails no increased risks compared with bladder drainage.
Friedrich
J
J
Division of Transplantation, Departments of Surgery and Urology, University of Washington, Seattle, Washington 98195, USA.
Charpentier
K
K
Marsh
C L
CL
Bakthavatsalam
R
R
Levy
A E
AE
Kuhr
C S
CS
D000328:Adult; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D006801:Humans; D016035:Pancreas Transplantation / Q000379:methods*; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder; D014861:Washington