En Bloc Retroperitoneal Pancreas–Kidney Transplantation With Duodenoduodenostomy Using Pediatric Organs

Schenker, Peter; Flecken, M.; Vonend, Oliver; Wünsch, Andreas; Traska, T; Viebahn, Richard

doi:10.1016/j.transproceed.2009.06.113

Cited by 15 publications

(13 citation statements)

References 15 publications

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“…Following modification to a hand‐sewn DD technique, no further episodes of enteric anastomotic bleeding were seen. Although based on a small sample size, we agree with others that when performing a DD, a two‐layer hand‐sewn technique should be used to minimize the risk of anastomotic bleeding (6, 7, 9).…”

Section: Discussionsupporting

confidence: 68%

Duodenoduodenostomy in pancreas transplantation

Gunasekaran

Wee

Rabets

et al. 2011

Clinical Transplantation

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Enteric drainage (ED) using duodenojejunostomy (DJ) is an established technique in pancreatic transplantation. Duodenoduodenostomy (DD), an alternative ED technique, may provide unique advantages over DJ. We compared our experience with these two types of ED through a retrospective review of all pancreas transplants performed at our institution from November 2007 to November 2009. The allograft duodenum was anastomosed to the recipient jejunum or duodenum. Duodenal drainage was performed by a stapled or hand-sewn technique. Patient demographics, operative times, major post-operative complications, and graft survival data were analyzed. Of 57 pancreas transplants, DJ was performed in 36 patients, stapled DD in 14 patients, and hand-sewn DD in seven patients. Two DD grafts (9.5%) thrombosed compared with no DJ grafts (p = NS). Enteric leak and small-bowel obstruction occurred in 3 of 36 DJ patients and in two DD patients (p = NS). Gastrointestinal bleeding occurred more frequently in stapled DD compared with DJ (4 vs. 0, p < 0.015). In conclusion, DD is technically feasible with no increase in operative time or enteric complications. GI bleeding rates appear to be higher following DD (stapled) technique. Potential complications of DD should be balanced against the benefits conferred by this technique.

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Section: Discussionsupporting

confidence: 68%

Duodenoduodenostomy in pancreas transplantation

Gunasekaran

Wee

Rabets

et al. 2011

Clinical Transplantation

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“…The DD-technique has been previously described in a series of 21 patients (11), and one case report on the use of an en bloc pediatric pancreas and kidney graft using DD-technique (12). In these studies, few of the technical challenges and advantages were reported.…”

Section: Discussionmentioning

confidence: 99%

Pancreas Transplantation With Enteroanastomosis to Native Duodenum Poses Technical Challenges—But Offers Improved Endoscopic Access for Scheduled Biopsies and Therapeutic Interventions

Horneland

Paulsen

Lindahl

et al. 2015

American Journal of Transplantation

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“…In our experience, other potential contraindications to portalenteric drainage using the anterior approach are listed in Table 1. In addition to the lateral or retroperitoneal approach introduced by Boggi [3], a number of other variations of portal-enteric drainage have evolved over the years to minimize technical challenges including the use of diverting Roux-en-y limbs for the enteric anastomosis (either with or without a venting jejunostomy), duodeno-gastric drainage, and, more recently, duodeno-duodenal drainage [12,[19][20][21][22][23][24][25][26][27][28][29][30].…”

Section: Discussionmentioning

confidence: 99%

Pancreas Transplantation with Systemic-Enteric Drainage when Portal-Enteric Drainage is Contraindicated

Ac²,

Orl³

et al. 2014

Pancreat Disord Ther

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Although most Pancreas Transplants (PTs) are currently performed with exocrine enteric drainage, <20% also incorporate portal venous delivery of insulin (portal-enteric drainage). The purpose of this study was to analyze outcomes according to surgical technique. Methods:We retrospectively reviewed outcomes in 202 consecutive PTs in 192 patients at our center. All patients received either r-ATG or alemtuzumab induction with tacrolimus/mycophenolate ± steroids. Results:From 11/01 to 3/13, we performed 162 simultaneous kidney-PTs (SKPT), 35 sequential PTs after kidney, and 5 PTs alone (40 solitary PTs). A total of 179 (89%) were performed with portal-enteric and 23 with systemic-enteric drainage; all PTs were initially approached as intent-to-treat with portal-enteric drainage. Indications for systemic-enteric drainage were pancreas retransplantation following primary PT with portal-enteric drainage (N=9), central obesity (N=7), and unfavorable vascular anatomy (n=7). The systemic-enteric drainage group was characterized by more pancreas retransplants (39% versus 4%, p<0.0001), more solitary PTs (35% versus 18%, p=0.09), more African-Americans (39% versus 17%, p=0.02) and more patients with C-peptide positive diabetes (30% versus 13%, p=0.054) compared to the portal-enteric drainage group. Although the proportions of male recipients (70% versus 56%), recipients ≥ 80 kg (30% versus 24%), and early relaparotomy rates (48% versus 36%) were all numerically higher in systemic-enteric versus portal-enteric PTs, respectively, none of these differences were significant. The incidence of early PT thrombosis was 4% in systemic-enteric compared to 8% in portal-enteric PTs (p=NS). With a mean follow-up of 5 years in systemic-enteric compared to 6 years in portal-enteric PT recipients, respective patient survival (70% versus 84%) and pancreas graft survival (61% versus 60%) rates were comparable; respective death-censored kidney graft survival (81% versus 82%) rates were similar. Conclusion:In patients with disqualifying technical features for PT with portal-enteric drainage, comparable overall results can be achieved with systemic-enteric PT as a secondary technique.

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En Bloc Retroperitoneal Pancreas–Kidney Transplantation With Duodenoduodenostomy Using Pediatric Organs

Cited by 15 publications

References 15 publications

Duodenoduodenostomy in pancreas transplantation

Duodenoduodenostomy in pancreas transplantation

Pancreas Transplantation With Enteroanastomosis to Native Duodenum Poses Technical Challenges—But Offers Improved Endoscopic Access for Scheduled Biopsies and Therapeutic Interventions

Pancreas Transplantation with Systemic-Enteric Drainage when Portal-Enteric Drainage is Contraindicated

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