title: Pancreas transplantation: advantages of both enteric and bladder drainage combined in a two-step approach.
abstract: BACKGROUND
  Although there is a tendency to perform enteric drainage of pancreas transplants in simultaneous pancreas-kidney (SPK) transplantation, bladder drainage is still preferable in pancreas transplantation alone (PTA) or after a previous kidney transplantation (PAK). Our hypothesis was that enteric conversion of a bladder drained pancreas is an effective and safe procedure. We studied the complication rate and physiological effects of enteric conversion in patients with primary bladder-drained SPK transplantation.
  
  
  METHODS
  We performed 51 enteric conversions in bladder-drained SPK transplant recipients. As we observed a low complication rate, with time enteric conversions were also performed for less strict and severe indications.
  
  
  RESULTS
  The main indications for conversion were urological problems, metabolic complications and reflux-pancreatitis. The median transplantation-conversion interval was 12 months (range 2-40 months). Post-operative complications consisted of seven urinary tract infections, two low-grade superficial wound infections, one minor bleeding, one phlebitis and one paralytic ileus. In two patients, a relaparotomy was necessary. No graft rejection following enteric conversion was found. Long-term renal and pancreatic function were not affected by the enteric conversion. Three-year patient, kidney and pancreas survival rates after enteric conversion were 93, 97 and 93%, respectively (censored data).
  
  
  CONCLUSIONS
  Enteric conversion after pancreas transplantation is an effective and safe procedure. Therefore, we suggest a policy of a two-step approach of primary bladder drainage followed by an enteric conversion of the pancreas in a selected group of SPK patients.
authors.affiliation: Department of Transplantation Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Pieter
authors.initials: P
authors.lastname: van de Linde
authors.forename: Paul J M
authors.initials: PJ
authors.lastname: van der Boog
authors.forename: Andrzej G
authors.initials: AG
authors.lastname: Baranski
authors.forename: Johan W
authors.initials: JW
authors.lastname: de Fijter
authors.forename: Jan
authors.initials: J
authors.lastname: Ringers
authors.forename: Alexander F M
authors.initials: AF
authors.lastname: Schaapherder
mesh_terms: D000714:Anastomosis, Surgical / Q000379:methods; D004322:Drainage; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods; D016035:Pancreas Transplantation / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012086:Reoperation; D013530:Surgical Wound Infection / Q000145:classification / Q000453:epidemiology; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D014552:Urinary Tract Infections / Q000453:epidemiology