Abstract
Background. In the past, enteric drainage or the omission of induction immunotherapy has been
shown to be predictive of suboptimal outcomes of simultaneous pancreas-kidney (SPK)
transplantation. We have reassessed the need for bladder drainage and induction immunotherapy
to optimize the outcome of SPK transplantation. Methods. One hundred consecutive recipients of SPK transplants who received mycophenolate
mofetil and tacrolimus immunosuppression were studied. The first 50 recipients had
bladder-drained pancreas allografts and received induction immunotherapy. The results
were compared with the next 50 recipients who had enteric-drained pancreas allografts,
which included a subgroup (n = 17 patients) who were randomized to receive no induction
immunotherapy. Results. The 1-year actuarial patient, kidney, and pancreas survival rates in the bladder-drainage
group were 98.0%, 94.0%, and 94.0%, respectively. The 1-year actuarial patient, kidney,
and pancreas survival rates in the enteric-drainage group were 96.8%, 96.8%, and 89.4%,
respectively. In the enteric-drainage group, the incidence of rejection at 1 year
was 6.1% in recipients who received induction therapy versus 23.5% in recipients who
did not receive induction therapy. The average number of readmissions per recipient
was 1.8 in the bladder-drainage group versus 0.9 in the enteric-drainage group. Conclusions. Primary enteric drainage of the pancreas allograft in recipients of SPK transplantation
is the preferred surgical technique in the tacrolimus/mycophenolate mofetil era. (Surgery
2000;128:726-37.)
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Article info
Footnotes
*Reprint requests: Dixon B. Kaufman MD, PhD, Northwestern University Medical School, Department of Surgery, Division of Transplantation, 675 N St Clair St, Galter Pavilion, Suite #17200, Chicago, IL 60611.
**Surgery 2000;128:726-37
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
