Exocrine drainage in vascularized pancreas transplantation in the new millennium

Table 8 Portal-duodenal/gastric drainage: Literature review

Center, authors, year, ref., and study design	Number and type of transplant	Complications	Readmissions and reoperations	1 yr patient survival	1 yr pancreas survival
New York Medical College, Westchester Medical Center, Gunasekaran et al[28], Retrospective	DJ: 36; DD: 21; stapled 14, hand-sewn 7	Thrombosis: None in DJ, 2 in DD (P = NS); Enteric leak and small-bowel obstruction: 3 in DJ, 2 in DD (P = NS); Gastrointestinal bleeding: None in DJ, 4 in DD (P = 0.015)	ND	94% with DJ, 95% with DD	89% with DJ, 86% with DD
Louisiana State University, Shokouh-Amiri et al[27], Retrospective	Group 1: Allograft jejunum to stomach, n = 30; Group 2: Allograft duodenum to jejunum with Roux-en-Y venting jejunostomy, n = 30	In Group 1: Pancreatectomy in 3, CMV in 7, acute rejection in 4, death in 3; In Group 2: Pancreatectomy in 1, CMV in 2, acute rejection in 6, death in 2 (all P = NS)	Major complications: 4 in group 1, 10 in group 2	94% in group 1, 96% in group 2	85% in group 1, 83% in group 2
Bandeirantes Hospital, Sao Paulo, Brazil, Perosa et al[30], Retrospective	43 PAK, 10 PTA with DD	Thrombosis in 5 (9%); 4 additional pancreas graft losses (including 2 deaths with functioning grafts); Acute rejection in 9 (17%); major infection in 24 (45%)	Readmissions: Mean 1.1; Mean length of hospital stay: 11.8 d; Reoperations in 9 (17%)	96%	83%
University Hospital Bochum, Germany, Walter et al[31], Retrospective	DD in 125 (64% with portal outflow); DJ in 116 (12% with portal outflow)	GI bleeding in 14 with DD, 4 with DJ; Thrombosis in 5 with DD, 18 with DJ (P = 0.002); Acute rejection in 29% in DD vs 31% in DJ	2 anastomotic leaks with DD, 6 with DJ; Pancreatectomy in 14 with DD, 21 with DJ; Early relaparotomy in 42% DD vs 48% DJ, all P = NS	96% in both groups	82% with DD, 78% with DJ
Oslo University Hospital, Rikshospitalet, Norway, Horneland et al[32], Retrospective	20 SPK, 17 PTA, 3 PAK with DD (n = 40); 30 SPK 7 PTA, 3 APK with DJ (n = 40); In sequential eras	Thrombosis in 13% DD vs 5% DJ; Acute rejection in 23% DD vs 28% DJ, both P = NS	Reoperations in 40% DD vs 30% DJ; Mean length of hospital stay 19 d DD vs 16 d DJ, both P = NS	97.5% DD vs 92.5% DJ	Overall pancreas survival was 80% with DD, 87.5% with DJ (P = NS)
Scientific-Research Institute of Sklifosovsky, Moscow, Russia, Khubutia et al[123], retrospective	Group 1: 15 DJ; Group 2: 17 DD	Acute reject ion in 13% DJ vs 12% DD; Major infections in 20% DJ vs 6% DD, both P = NS	Surgical complications in 20% DJ vs 23.5% DD, P = NS	93% DJ vs 94% DD	Pancreas survival 93% DJ vs 94% DD; kidney survival 93% DJ vs 88% DD

DD: Duodeno-duodenostomy; CMV: Cytomegalovirus; ND: Not determined/no data; DJ: Duodeno-jejunostomy; NS: Not significant.