title: A single-centre experience of Roux-en-Y enteric drainage for pancreas transplantation.
abstract: Exocrine drainage following pancreas transplantation can be achieved by drainage into the bladder or bowel, the latter typically by direct duodeno-jejunostomy; the use of Roux-en-Y enteric drainage is uncommon. We report a retrospective analysis of a single-centre experience of Roux-en-Y enteric drainage following pancreas transplantation. Over a 14-year period (2001-2015), 204 consecutive adult pancreas transplants were performed (96.6% simultaneous pancreas and kidney transplants), of which 26.0% were from donors after circulatory death (DCD). During a median follow-up of 67 months (range 13-183 months), 14 (6.9%) recipients experienced complications related to their enteric drainage. Complications during follow-up included early enteric anastomotic haemorrhage (five patients), non-anastomotic enteric bleeding (one patient), small bowel obstruction (four patients) and graft duodenal perforation (two within 6 weeks, five beyond 12 months). No recipient lost their graft as a direct result of complications related to enteric drainage. Patient and pancreas graft survival at 1 year was 99.0% and 94.0% and at 5 years 91.3% and 84.9%, respectively. We conclude that Roux-en-Y enteric drainage following pancreas transplantation is a safe and effective procedure and facilitates graft salvage in the event of graft duodenal perforation.
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Irum
authors.initials: I
authors.lastname: Amin
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Butler
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Gail
authors.initials: G
authors.lastname: Defries
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Neil K
authors.initials: NK
authors.lastname: Russell
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Simon J F
authors.initials: SJ
authors.lastname: Harper
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Asif
authors.initials: A
authors.lastname: Jah
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Kourosh
authors.initials: K
authors.lastname: Saeb-Parsy
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Pettigrew
authors.affiliation: Department of Surgery, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.
authors.forename: Christopher J E
authors.initials: CJ
authors.lastname: Watson
mesh_terms: D000328:Adult; D000713:Anastomosis, Roux-en-Y / Q000379:methods*; D000714:Anastomosis, Surgical; D004322:Drainage / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D011183:Postoperative Complications / Q000601:surgery; D011446:Prospective Studies; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Roux-en-Y; anastomotic haemorrhage; duodenal perforation; enteric drainage; pancreas transplant