Exocrine drainage in vascularized pancreas transplantation in the new millennium

Table 4 Bladder vs enteric drainage: Literature review

Center, authors, year, ref., and study design	Number and type of transplant	Complication/enteric conversion	Acute rejection/graft loss	Reoperation and readmissions	1 yr patient survival	1 yr pancreas (and kidney) graft survival
University of Maryland, Kuo et al[35], Retrospective	23 SPK ED	ED: Fewer UTIs and urologic complications	ND	ND	ED 100%; BD 96%	ED 88%; BD 91%
University of Chicago, Newell et al[33], Retrospective	SPK; ED 12; BD 12	Acidosis and dehydration less with ED (P < 0.005); Hematuria; BD 25%; ED 0%; No anastomotic leaks in either group; No intra-abdominal infection in either group; Enteric conversion: 33%	ND	BD: 4 patients underwent enteric conversion	BD 100%; ED 83.3%	BD 91.7%; ED 83.3%
University of Wisconsin, Sollinger et al[80]; Retrospective	1000 SPK; BD 390; ED 610	Pancreas graft thrombosis; BD 2.3% ED 3.6%; Infection; BD 1.8% ED 0.8%; Pancreatitis; BD 1.3% ED 0.5%; Pancreatic leak BD: 12% ED: 5% (P = 0.06)	Kidney rejection; BD 29%; ED 19%; Pancreas rejection; BD 12.1%; ED 5.4%	ND	Similar in both groups	Similar kidney, and pancreas graft survival in both groups
Pirsch et al[37], Retrospective	48 BD; 78 ED	Opportunistic infections; ED: 12% BD: 31% (P = 0.002); CMV; BD 21% ED 4% (P = 0.04); Fungal infection; BD 17% ED 4%; UTI BD 63% ED 20% (P = 0.0001)	Kidney rejection; BD 38%; ED 30%; Steroid-resistant rejection; BD 19%; ED 17%
University of Washington, Friedrich et al[90], Retrospective	34; ED 17; BD 17	ED 41%; BD 53%; Enteric conversion: 5%	ED 29%; BD 24%	Readmissions: ED 41%; BD 47%	ND	ND
University of Tennessee-Memphis, Stratta et al[41], Prospective	BD 16; ED 16	UTI BD 50% ED 19%; Urologic complications; BD 25% ED 12.5%; Dehydration BD 100% ED 44%	BD 44%; ED 31% P = NS	BD 25%; ED 25%; Readmissions: BD 2.6 ± 1.8; ED 1.75 ± 1.2	BD 88%; ED 94%	Kidney survival; BD 92%; ED 93%; Pancreas survival BD 81%; ED 88%
Albert Einstein Medical Center, Bloom et al[34], Retrospective	71 SPK; BD 37; ED 34	Dehydration BD 34% ED 3.4%; Acidosis BD 41% ED 0% Pancreatitis BD 40% ED 3.4% UTI BD 71% ED 27% (P < 0.005) Enteric conversion: 19%	BD: 13.5%; ED: 14.7%		Similar between groups	Pancreas allograft survival was similar between groups
Emory University, Pearson et al[36], Retrospective	SPK; BD 55; ED 11	BD; UTI 78%; Hematuria 27%; Dehydration 38%; ED no complication
University of Pittsburgh Corry et al[43], Retrospective	BD 44; ED 199	Overall BD 41% ED 26%; Anastomotic bleeding; BD 16% ED 5%; Fistula BD 14% ED 6%		BD 24%; ED 16%		BD 44%; ED 69%
Toronto General Hospital, Cattral et al[40], Retrospective	SPK; BD 20; ED 20	UTI: Similar in both groups; CMV infections were significantly less in the ED group	BD 37%; ED 15%; (P = 0.20)	BD 1 patient to ligate an arteriovenous fistula in the pancreas graft; ED 4 patients; (bleeding in one, partial wound dehiscence in one, negative laparotomy in two)	BD 95%; ED 100%	Kidney graft survival; BD 95%; ED 100%; Pancreas graft survival; BD 95%; ED 100%
Wake Forest University, Stratta et al[46], Retrospective	297 SPK; SE 171 (58%); PE 96 (32%); SB; 30 (10%)	No differences were seen in surgical complications including pancreas thrombosis; Infections: SE 49%; PE 85%; BD 63%	SE 19%; PE 26%; BD 30%	Readmissions: SE 61%; PE 63.5%; BD 63%	SE 97%; PE 99%; BD 97%	Kidney; SE 94%; PE 98%; BD 93%; Pancreas; SE 87%; PE 92%; BD 87%

BD: Bladder drainage; ED: Enteric drainage; SB: Systemic-bladder; SE: Systemic-enteric; PE: Portal-enteric; UTI: Urinary tract infection; CMV: Cytomegalovirus; ND: Not determined/no data.