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Simultaneous pancreas/kidney transplantation--a comparison of enteric and bladder drainage of exocrine pancreatic secretions.

Publication ,  Journal Article
Kuo, PC; Johnson, LB; Schweitzer, EJ; Bartlett, ST
Published in: Transplantation
January 27, 1997

Simultaneous pancreas/kidney transplantation (SPK) has evolved to become a therapeutic option for patients with renal failure resulting from type 1 diabetes mellitus. However, the appropriate route for drainage of the exocrine secretions of the pancreas allograft remains unclear. While bladder drainage (BD) is the current state of the art, it is associated with a high frequency of urologic complications, including urinary tract infections, hematuria, metabolic acidosis, dehydration, and reflux pancreatitis. Although enteric drainage (ED) is the more physiologic route, it has been associated in the past with decreased graft survival and increased infectious complications. In addition, BD offered a technique for detection of rejection through measurement of urinary amylase. However, with the advent of improved immunosuppression and antibiotic therapy, percutaneous pancreas biopsy, improved radiologic imaging, and greater understanding of pancreas transplantation, we hypothesized that ED could be performed without increased morbidity or cost. A group of 23 consecutive SPK was performed with ED during the period from July 1995 to November 1995. Another 23 age- and sex-matched recipients of SPK with BD performed from November 1994 to June 1995 served as a historical control group. Because of the differing lengths of follow-up, data were analyzed with respect to the first six months posttransplant. ED and BD were associated with equivalent actuarial one-year patient and graft survival rates: 100% and 88% for ED, and 96% and 91% for BD, respectively. Hospital charges, length of stay, readmissions, rejection, sepsis-related procedures were also equivalent in ED and BD. However, ED was associated with significantly fewer urinary tract infections and urologic complications. In addition, no grafts were lost as the result of sepsis. In the setting of SPK, ED represents a viable alternative to BD for primary drainage of pancreas exocrine secretions. Further studies with extended lengths of follow-up are necessary to confirm our observations.

Duke Scholars

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

January 27, 1997

Volume

63

Issue

2

Start / End Page

238 / 243

Location

United States

Related Subject Headings

  • Urinary Bladder
  • Surgery
  • Sepsis
  • Postoperative Complications
  • Pancreas Transplantation
  • Pancreas
  • Male
  • Length of Stay
  • Kidney Transplantation
  • Kidney Failure, Chronic
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Kuo, P. C., Johnson, L. B., Schweitzer, E. J., & Bartlett, S. T. (1997). Simultaneous pancreas/kidney transplantation--a comparison of enteric and bladder drainage of exocrine pancreatic secretions. Transplantation, 63(2), 238–243. https://doi.org/10.1097/00007890-199701270-00011
Kuo, P. C., L. B. Johnson, E. J. Schweitzer, and S. T. Bartlett. “Simultaneous pancreas/kidney transplantation--a comparison of enteric and bladder drainage of exocrine pancreatic secretions.Transplantation 63, no. 2 (January 27, 1997): 238–43. https://doi.org/10.1097/00007890-199701270-00011.
Kuo PC, Johnson LB, Schweitzer EJ, Bartlett ST. Simultaneous pancreas/kidney transplantation--a comparison of enteric and bladder drainage of exocrine pancreatic secretions. Transplantation. 1997 Jan 27;63(2):238–43.
Kuo, P. C., et al. “Simultaneous pancreas/kidney transplantation--a comparison of enteric and bladder drainage of exocrine pancreatic secretions.Transplantation, vol. 63, no. 2, Jan. 1997, pp. 238–43. Pubmed, doi:10.1097/00007890-199701270-00011.
Kuo PC, Johnson LB, Schweitzer EJ, Bartlett ST. Simultaneous pancreas/kidney transplantation--a comparison of enteric and bladder drainage of exocrine pancreatic secretions. Transplantation. 1997 Jan 27;63(2):238–243.

Published In

Transplantation

DOI

ISSN

0041-1337

Publication Date

January 27, 1997

Volume

63

Issue

2

Start / End Page

238 / 243

Location

United States

Related Subject Headings

  • Urinary Bladder
  • Surgery
  • Sepsis
  • Postoperative Complications
  • Pancreas Transplantation
  • Pancreas
  • Male
  • Length of Stay
  • Kidney Transplantation
  • Kidney Failure, Chronic