Enteric conversion after pancreatic transplantation: resolution of symptoms and long-term results.
OBJECTIVE
Bladder drainage (BD) of pancreatic transplants is associated with a unique set of complications. We intended to analyze the incidence, indications, complications and long-term results of enteric conversion procedures (EC).


METHODS
Using a prospective database, 32 EC patients out of 433 simultaneous pancreas-kidney-transplant (SPK) recipients were identified. Graft and patient survival rates were compared with those after primary enteric drainage (ED).


RESULTS
The mean SPK-EC interval was 5.0 yr, and the mean patient follow-up was 13.8 yr. Indications for EC were genitourinary symptoms (62.5%), duodenal complications (15.6%), graft pancreatitis (12.5%), pyelonephritis (6.3%), and metabolic acidosis (3.1%). All patients reported significant long-term resolution of symptoms. Surgical complications, reoperations, early graft loss, and 30-d mortality occurred in 31.3%, 25.0%, 6.3%, and 3.1% of cases, respectively. Pancreatic graft and patient survival rates at 1, 5, and 10 yr after SPK were comparable between EC patients and ED patients at the same institution.


CONCLUSIONS
For the treatment of symptoms associated with BD, EC results in excellent long-term graft function and significant resolution of symptoms even years after SPK. Postoperative morbidity after EC including early reoperation and graft loss, however, has to be considered.
Department of Surgery-Campus Grosshadern, University of Munich, Munich, Germany. axel.kleespies@med.uni-muenchen.de
Axel
A
Kleespies
Michael
M
Mikhailov
Philipe N
PN
Khalil
Gerhard
G
Preissler
Markus
M
Rentsch
Helmut
H
Arbogast
Wolf-Dieter
WD
Illner
Christiane J
CJ
Bruns
Karl-Walter
KW
Jauch
Martin K
MK
Angele
D000328:Adult; D000714:Anastomosis, Surgical; D015331:Cohort Studies; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007677:Kidney Function Tests; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000401:mortality*; D011183:Postoperative Complications; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*