Exocrine drainage in vascularized pancreas transplantation in the new millennium

Table 6 Systemic-enteric drainage: Literature review

Center, authors, year, ref., and study design	Number and type of transplant	Complications	Readmission/reoperation/length of stay	1 yr patient survival	1 yr kidney/pancreas survival
Medical University of South Carolina, Douzdjian et al[105], Retrospective	ED 16; BD 26	Recurrent/persistent urinary complications BD 46% ED 6% (P = 0.01); Dehydration BD 27% ED 6% (P = 0.05); Pancreatitis BD 8% ED 6% (P = NS); Wound infection BD 12% ED 19% (P = 0.5)	Readmissions BD: 1.7 ± 1.5; ED 1.2 ± 1.2 d (P = 0.2) Reoperations BD 23% ED 0 (P = 0.04); Length of stay BD: 12.9 ± 5.6 ED: 20.4 ± 9.6 d, P = 0.007	BD 96%; ED 94%; P = 0.6	Kidney BD 85%; ED 87%; Pancreas BD 90%; ED 85% (P = 0.6)
Institut de Malaties Digestives, Spain, Heredia et al[94], Retrospective	205 SPK; ED 97	Duodenal leaks: (n = 11); Acute rejection (n = 6); CMV infection (n = 3); Technical failure (n = 2); Death: (n = 2) as a consequence of sepsis	Reoperation for duodenal leak: Roux-en-Y technique: (n = 3) DJ technique: (n = 2) Transplantectomy: (n = 6)	ND	ND
Toronto General Hospital, Spetzler et al[95], Retrospective	Total 284; 191 SPK (67.3%); 93 PAK (32.7%)	Duodenal leak (incidence 6.3%), 12 (67%) occurred within the first 100 d after transplantation	Six grafts (33%) were rescued by duodenal segment resection;	ND	ND
Innsbruck University Hospital, Austria, Steurer et al[92], Retrospective	40 ED	Intra-abdominal infection - 11 (27.5%)	Reoperation for intra-abdominal infection Pancreatectomy: 5 Necrosectomy and drainage: 5 Percutaneous drainage: 1	ND	ND
Ruhr-University Bochum, Germany, Ziaja et al[104], Retrospective	30 SPK	Perioperative mortality 3.3%	Early relaparotomy was required in 20%; pancreatectomy in 10%	ND	ND
Indiana University, Fridell et al[106], Retrospective	49; SPK; All ED	Death: (n = 2) (1 patient died from multi-system organ failure and a second from graft vs host disease); Pancreatic graft failures: (2); renal graft failure: (1)	Relaparotomies: (n = 5) bowel obstructions: (2) anastomotic leak: (1) ureteral stricture: (1)	96%	Kidney 94%; Pancreas
University of Pittsburgh, Corry et al[107], Retrospective	104 SPK	Graft loss in 6 patients, Death in one patient	Splenic artery hemorrhage: (1) ND	98%	92%; Kidney 95%, Pancreas 83%
University of Maryland, Bartlett et al[108], Prospective	27; Solitary pancreas transplants	One graft lost to acute rejection in the tacrolimus group because of patient noncompliance	ND	ND	90% in patients receiving tacrolimus, 53% in patients receiving cyclosporine (P = 0.002)

BD: Bladder drainage; ED: Enteric drainage; CMV: Cytomegalovirus; ND: Not determined/no data; DJ: Duodeno-jejunostomy.