Effect of the surgical technique on long-term outcome of pancreas transplantation

Abstract

To date there is no general consensus as to the best surgical technique for pancreas transplantation. Patients with a pancreas transplant functioning for 3 years or more were retrospectively investigated to compare three surgical techniques: segmental graft with duct obstruction (DO), whole graft with bladder drainage (BD), and whole graft with enteric drainage (ED). Several parameters were studied: patient and graft survival, rejection, long-term surgical and medical complications, and endocrine function. The best results in terms of graft survival and quality of metabolic control were obtained in the group that underwent whole graft transplantation with ED. At 3 years, overall pancreas graft survival was 65 % for ED, 60 % for BD, and 47 % for DO. This surgical method has become the preferred technique in our unit.

Outcome of surgical complications following simultaneous pancreas-kidney transplantation

“…In our cohort of patients, an identical proportion of patients in the SC and NSC groups were bladder-drained and entericdrained. There is no evidence in the literature to suggest that either technique reduces surgical complications, but some studies have shown improved graft survival for bladderdrained grafts [25,35], others for enteric-drained grafts [38] and some have shown no difference in graft survival between the two methods [26,36].…”

First World Consensus Conference on pancreas transplantation: Part II – recommendations

“…190 Two recent long-term studies reported that >40% of patients with bladder drainage require enteric conversion at some point in time. 197,207 Additionally, bladder drainage increased the rate of metabolic and urologic complications, 188,198,[208][209][210][211][212][213][214][215][216] and did not improve immunologic outcome of either SPK 187,[190][191][192][196][197][198]205,206,208,214,217,218 or solitary pancreas transplantations. 70,171,219 Duodeno-duodenostomy (vs. duodeno-jejunostomy) was not considered to clearly increase the overall rate of surgical complications after pancreas transplantation, despite higher rates of bleeding.…”