Impact of Portal Venous Pancreas Graft Drainage on Kidney Graft Outcome in Simultaneous Pancreas-Kidney Recipients Reported to UNOS

Abstract

Clinical data on the potential immunologic impact of portal (PD) vs. systemic (SD) venous pancreas graft drainage on outcome remains controversial.We reviewed the UNOS database to study the effect of PD vs. SD on the incidence of kidney graft rejection and survival in first cadaveric simultaneous pancreas-kidney (SPK) recipients transplanted 1994-2001. We studied three groups: all SPK (n = = 6629, 13% PD) (group I), SPK on tacrolimus (n = = 3563, 17% PD) (group II), and SPK on tacrolimus performed at centers with significant PD experience (n = = 948, 46% PD) (group III). The cumulative kidney graft rejection incidence for PD vs. SD was only significantly different in group I (for PD vs. SD, respectively: at 6 months, 31% vs. 36% [p = = 0.015]; at 1 year, 37% vs. 43% [p = = 0.006]). Kidney graft survival was similar in all groups for PD vs. SD. Multivariate analysis of group III showed only transplantation during the earlier era (1994-96), but not SD, to be an independent risk factor for kidney graft rejection.Portal venous pancreas graft drainage does not affect kidney graft rejection and survival in SPK recipients on tacrolimus. Our data suggests that the efficacy of current immunosuppressive protocols and increasing center experience are clinically much more relevant than any potential immunologic advantage of portal venous drainage in SPK recipients.

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

“…No study demonstrated that portal venous drainage increases surgical risk 187,[229][230][231][232][233][234][235] but, on the other hand, no study showed either an immunologic, 199,207,208,229,236 or a metabolic advantage . 233,234,[237][238][239][240][241][242][243][244]…”

Impact of pancreatic venous drainage site on long‐term patient and graft outcome in simultaneous pancreas‐kidney transplantation

“…Portal venous drainage of pancreas allograft was considered to be able to induce a systemic hyporesponsiveness by portal venous delivery of antigen, although the mechanism by which the liver can induce a state of immunologic hyporesponsiveness following portal antigen presentation are not clearly understood. Several authors (7,8,18) showed lower pancreas and kidney rejection rate sometimes correlated with better graft survival in patients with portal venous drainage of pancreas graft while other authors (10,14,19) and IPTR data did not demonstrate any significant difference in rejection and survival rate between recipients with portal or systemic venous drainage of pancreas allograft. According to the last authors and IPTR we did not show any significant difference between the two groups of patients, although rejection of one or both grafts was surprisingly the most common cause of pancreas and/or kidney loss in recipients with portal venous drainage of pancreas allograft.…”

A comparison of portal venous versus systemic venous drainage in pancreas transplantation

“…Previous studies that tackled this subject did so using smaller sample sizes. A study by Troppman et al 17 did use the UNOS data to evaluate this subject, but this was with a smaller sample size, and was published in 2004. Based on current literature, this study comprises a larger sample size and contains more recent information.…”