Abstract
Background: Most pancreas transplants are performed with systemic venous delivery of insulin
and bladder drainage of the exocrine secretions (systemic-bladder [S-B]). To develop
a more physiologic procedure, we performed pancreas transplantations with portal venous
delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric
[P-E]). Methods: During an 11-month period, we prospectively alternated 32 consecutive pancreas transplant
recipients to either S-B (n = 16) or P-E (n = 16) drainage with standardized immunosuppression.
Results: Patient, kidney, and pancreas graft survival rates after simultaneous kidney-pancreas
transplantation were 91% S-B versus 92% P-E, 91% S-B versus 92% P-E, and 82% S-B versus
92% P-E, respectively. Pancreas graft survival rates after solitary pancreas transplantation
were 80% S-B versus 75% P-E. There were no graft losses either to immunologic or infectious
complications in either group, but the incidence of acute rejection was slightly higher
in the S-B group (44% S-B vs 31% P-E, P = NS). The cost and length of the initial
hospital stay were similar between groups. The incidence of operative complications,
major infections, and cytomegalovirus infections were likewise comparable. However,
the S-B group was characterized by a slight increase in the number of readmissions,
urinary tract infections, and urologic complications. Furthermore, metabolic acidosis
and dehydration were more common in the S-B group. Conclusions: Pancreas transplantation with P-E drainage can be performed with short-term results
comparable to those of transplantation with S-B drainage. (Surgery 2000;127:217-26.)
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Article info
Publication history
Accepted:
September 18,
1999
Footnotes
*Reprints not available from the authors.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
