Exocrine drainage in vascularized pancreas transplantation in the new millennium

Table 9 Systemic vs portal-enteric drainage: Literature review

Center, authors, year, ref., study design and follow up	Number and types of transplant	Complications	Length of stay, readmissions and reoperations	1 yr patient survival	1 yr kidney and pancreas survival
University of Tennessee, Memphis, Stratta et al[44], Prospective, mean follow-up 17 mo	SE 27; PE 27	Incidences of acute rejection (33%) and major infection (52%) similar in both groups; Intraabdominal infections were slightly greater in the SE group (26% SE vs 11% PE); 2 deaths in SE group compared to one in PE group Pancreas Graft loss: 7 in SE compared to 4 in PE group, all P = NS	Readmissions (mean 2.8 SE vs 2.2 PE); Mean length of hospital stay: SE: 12.4 d; PE: 12.8 d; Relaparotomy: 8 in SE compared to 7 in PE group, all P = NS	SE 96%; PE 93%	Pancreas SE 74%; PE 85%; Kidney SE 96%; PE 93%
University of Maryland, Philosophe et al[45], Retrospective	SE: 63 SPK, 42 PAK, 26 PTA	Acute rejection: At 36 mo, the pancreas rejection rates were 21% for PE vs 52% for SE (P < 0.0001); the kidney rejection rates following SPK were 26% PE vs 43% SE (P = 0.017)	ND	36-mo patient survival rates were similar in both groups, 89% for PE vs 93% for SE	36-mo graft survival rates for all pancreas transplants were 79% with PE vs 65% with SE (P = 0.008)
Hospital Juan Canalejo, Coruña, Spain, Alonso et al[49] and Quintela et al[51], Retrospective, mean follow-up 23 mo	PE: 54 SPK, 55 PAK, 40 PTA; SE 18; PE 20	Incidences of intraabdominal infection and acute rejection episodes were not different between groups	Early relaparotomy no difference: SE: 34 d; PE: 20 d	PE: 80% vs SE: 86%	Death-censored pancreas (SKP and PAK) graft survival was 73% for PE and 81% for SE (P = NS)
Toronto General Hospital, Bazerbachi et al[53], Retrospective	SE 147; PE 45	In both groups, a complication occurred in 38% of patients in the first year; Major infections were not different between groups; 3-mo rejection rate was identical (6%) and the 1-yr rejection rate was 12.2% SE vs 13.3% PE; Most common reasons for pancreas graft loss in both groups were death with functioning graft (25%), graft thrombosis (13%), rejection (11%) and duodenal leak (9%)	Length of stay - mean 11 d vs 10 d in the SE vs PE; Most common causes of death in both groups were myocardial infarction (35%), cerebrovascular accident (13%) and cancer (13%); Most common causes of kidney graft loss in both groups were death with functioning graft (61%) and acute rejection (11%)	Patient survival did not differ at 5 yr (94% SE vs 89% PE) and 10 yr (85% SE vs 84% PE, P = NS)	Pancreas survival was similar at 5 yr (82% SE vs 76% PE) and 10 years (65% SE vs 60% PE); Kidney survival was similar at 5 yr (93% SE vs 84% PE) and 10 yr (82% SE vs 76% PE)
Medical University Innsbruck, Austria, Ollinger et al[120], Retrospective, Mean follow-up 8.3 yr	509 transplants in 4 eras including 34 PE and 146 SE (with DJ) in most recent era (2004-2011)	Thrombosis: 9% PE vs 5% SE, P = NS		5-yr patient survival 94%	5-yr pancreas survival 77% PE vs 74% SE
Hôpital Edouard Herriot, Lyon, France, Petruzzo et al[50], Retrospective	SE 36; PE 44; All SPK	No significant differences in long-term outcomes but the SE group had a higher incidence of pancreas graft loss secondary to thrombosis	No difference in total surgical complications	Patient survival rates 92% SE vs 95.5% PE	One-, 3-, 5-, and 8-yr pancreas survival rates were 75%, 60.6%, 56.7%, and 44%, respectively, in the SE group compared to 88.6%, 84.1%, 78.4%, and 31.3% in the PE group; One- 3-, 5-, and 8-yr kidney survival rates were 91.7%, 78.1%, 74.1%, and 57.9%, respectively, in the SE group compared to 93.2%, 88.6%, 78.4%, and 38.9% in the PE group

SE: Systemic enteric; PE: Portal enteric; ND: Not determined/no data; DJ: Duodeno-jejunostomy; NS: Not significant.