title: Portal-endocrine and gastric-exocrine drainage technique in pancreatic transplantation.
abstract: BACKGROUND
  Pancreas transplant (PTx) is an established treatment for patients with diabetes mellitus. Diagnosis of rejection has continued to be problematic. In 2007, a new technique of PTx with portal-endocrine and gastric exocrine (P-G) drainage was first performed at our institution. This technique facilitates access to pancreas allograft.
  
  
  OBJECTIVE
  To report our experience with the first 30 patients who underwent PTx using P-G technique.
  
  
  METHODS
  The first 30 patients who underwent PTx between 2007 and 2009 were studied. In these patients, arterial and venous anastomosis was similar to standard portal-enteric (P-E) technique, though contrary to other techniques of enteric drainage, the end of allograft jejunum was anastomosed to the anterior aspect of the stomach.
  
  
  RESULTS
  Donor and recipient demographic data, number of antigen matches and immunosuppressant were collected. All patients achieved euglycemia. 3 patients underwent pancreatectomy: 2 due to vessel thrombosis and 1 due to chronic rejection. 3 patients died-2 with functioning pancreatic and renal allografts. 7 patients with CMV and 4 patients with rejection were diagnosed with endoscopy of allograft duodenum and treated. 1-year patient and graft survival was 94% and 85%, respectively.
  
  
  CONCLUSIONS
  This novel technique of PTx has proven to be safe with good patient and allograft survival. Access to donor duodenum and pancreas allograft via endoscopy is unique to this technique and provides the added advantage of life-long easy access to allograft.
authors.affiliation: Department of Surgery, Willis Knighton/LSUHSC Regional Transplant Center, Louisiana State University Health Sciences Center, Shreveport, USA.
authors.forename: H
authors.initials: H
authors.lastname: Shokouh-Amiri
authors.affiliation: Department of Surgery, Willis Knighton/LSUHSC Regional Transplant Center, Louisiana State University Health Sciences Center, Shreveport, USA.
authors.forename: G B
authors.initials: GB
authors.lastname: Zibari
keywords: Acute rejection; Gastric-exocrine drainage; Immunosuppression; Pancreas transplant; Technique