Exocrine drainage in vascularized pancreas transplantation in the new millennium

Table 1 Bladder drainage: Literature review

Center, authors, year, ref., study design, and follow-up	Number and type of transplant	Complications	Enteric conversion	1 yr patient survival	1 yr pancreas graft survival
University of Minnesota, Hakim et al[67], Retrospective, mean follow-up 55 mo	n = 425 with bladder drainage, SPK - 53%; PAK - 23%; PTA - 24%	Duodenal stump complications - 20%; Duodenal leak - 10%; Recurrent UTI - 9%; Hematuria - 6% (19% required surgery); Bladder stone - 0.5%; CMV duodenitis - 1.5%; Graft loss - 9%	16%	ND	ND
University of Nebraska, Stratta et al[68], Retrospective, mean follow-up 44 mo	n = 201 with bladder drainage	Duodenal stump complications - 19%; Duodenal leak - 6% (all required surgery); Hematuria - 13% ( 30% required surgery); CMV duodenitis - 3%	13%	94%	80%
University of Wisconsin, Sollinger et al[69], Retrospective	n = 500; 338 with bladder drainage, 112 with enteric drainage	Duodenal leak - 15.4%; Graft Thrombosis - 0.7%; Hematuria - 3%; UTI - 52.5%; Graft loss - 13%; Death with a functioning graft - 8%	24%	96.4%	87.5%
The Ohio State University, Henry et al[70], Retrospective, mean follow-up 16 mo	n = 300 with bladder drainage	CMV - 2%; Intra-abdominal infection - 15%; Wound infection - 8%; Rejection - 55%; Hematuria - 14%; Bladder leak - 10%	4%	92%	82%
University of Maryland, Del Pizzo et al[71], Retrospective, mean follow-up 35 mo	n = 140; SPK - 68%, PAK - 25%, PTA - 7%	Urological complication - 50%; Bladder stone - 10%; Duodenitis - 11%; Retained foreign bodies - 12%; Bladder tumor - 2%	21%	ND	ND
Mayo Clinic Rochester, Gettman et al[72], Retrospective, mean follow-up 44 mo	n = 65	UTI - 59%; Hematuria - 26%; Allograft pancreatitis - 19%; Duodenal leaks 17%, (all required surgery); Ureteral lesions - 9%	ND	92%	86%
Hospital Universitario Spain, Medina Polo et al[73], Retrospective, mean follow-up 52 mo	n = 107, all SPK, bladder drainage in 58, enteric drainage in 49	UTI - 72%; Hematuria - 20%; Bladder stone - 8%; Reflux pancreatitis - 48%	10%	92.7%	78.1%
University of Nebraska, Sudan et al[74], Retrospective, mean follow-up 60 mo	n = 57, all with bladder drainage	UTI - 15%; Dehydration - 20%; Rejection - 1%	ND	95%	88%

SPK: Simultaneous pancreas-kidney; PAK: Pancreas after kidney; PTA: Pancreas transplantation alone; UTI: Urinary tract infection; CMV: Cytomegalovirus; ND: Not determined/no data.

Table 2 Advantages and disadvantages of bladder drainage of the exocrine secretions

Advantages

Safety

Reduced infection rate because of relative sterility of lower urinary tract

Control of anastomosis by urethral catheter decompression

Technical considerations

Relative simplicity because of favorable anatomic location of bladder

Bladder mobilization permits tension-free, multi-layer anastomosis

Bladder vasculature and urothelium promote healing

Direct access to exocrine secretions for monitoring pancreas allograft function

Detection of rejection by urinary parameters (amylase, lipase, insulin, cytology)

Cystoscopic access for either duodenal or pancreatic parenchymal biopsy

Disadvantages

Urologic problems

Hematuria, dysuria, cystitis, urethritis, urethral stricture or disruption, balanitis

Increased risk of lower urinary tract infections, stone formation, and urine leaks (either from bladder or duodenum)

Metabolic and volume problems

Dehydration, orthostasis, constipation, erythrocytosis

Metabolic acidosis

Miscellaneous problems

Reflux-associated hyperamylasemia or pancreatitis

Transitional cell (urothelial) dysplasia

Need for enteric conversion for refractory, persistent, or recurrent problems

Medication burden (massive amounts of bicarbonate supplementation)

Table 3 Enteric conversion: Literature review

Center, authors, year, ref., and study design	Overall rate (%)	Urologic indications # (%)	Metabolic indications # (%)	Pancreatitis/other indications # (%)	Operative complications # (%)
University of Wisconsin, Van der Werf et al[79], Retrospective	95/449 (21%)	90 (95)	1 (1)	4 (4)	21 (22)
Sollinger et al[80], Retrospective	160/390 (41%)	93 (58)	1 (0.6)	47 (29)	ND
University of Minnesota, West et al[81], Retrospective	79/500 (16%)	43 (54)	26 (33)	15 (19)	12 (15)
University of Nebraska, Sindhi et al[82], Retrospective	25/195 (13%)	7 (28)	18 (72)	0	3 (12)
University of Barcelona, Spain, Fernandez-Cruz et al[83], Retrospective	16/74 (22%)	0	0	16 (100)	Death 1 (6); Wound infection 2 (12); Anastomotic leak 3 (18)
Leiden University Medical Center, Netherlands, van de Linde et al[84], Retrospective	51/ND	39 (76)	23 (45)	Pancreatitis 2 (3); Fistula 1 (1)	UTI 7 (13); Minor bleeding 1 (0.5); Phlebitis 1 (0.5); Paralytic ileus 1 (0.5); Relaparotomy 2 (3)
University of Cincinnati, Kaplan et al[85], Retrospective	26 (32%)	13 (50)	13 (50)	0	Death 1 (3); Anastomotic bleeding 1 (3)
Beaumont Hospital, Ireland, Connolly et al[86], Retrospective	6/ND	3 (50); 2 hematuria; 1 UTI	3 (50)	ND	Pulmonary edema 1 (16)

UTI: Urinary tract infection; ND: Not determined/no data.

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.

Table 5 Advantages and disadvantages of enteric drainage of the exocrine secretions

Advantages

Safety

Lower rates of urinary tract infections and urologic complications

More “physiologic”; fewer metabolic and volume problems

Fewer readmissions

Technical considerations

Treats exocrine insufficiency (in patients following total pancreatectomy or in patients with cystic fibrosis

Avoidance of need for enteric conversion; lower relaparotomy rate

Can be used with either systemic or portal venous outflow

Disadvantages

Safety

Higher incidence of leakage of pancreatic enzymes, pancreatitis, peri-pancreatic fluid collections

Higher incidence of intra-abdominal abscess, peritonitis, sepsis

Anastomotic leaks, GI bleeding

Increased risk of wound infections, wound healing problems (contaminated case with GI tract breach)

Technical considerations

Selective need for enterolysis or diverting Roux en y limb

Loss of direct access to anastomosis and allograft for diagnosis and treatment

Miscellaneous problems

Inability to directly monitor exocrine secretions

GI: Gastrointestinal.

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.

Table 7 Portal-enteric drainage: Literature review

Center, authors, year, ref., study design and follow-up	Number and type of transplant	Complications	Readmissions, reoperation, length of stay	1 yr patient survival	1 yr kidney and pancreas graft survival
University of Tennessee, Stratta et al[122], Retrospective, mean follow-up 3 yr	PE 126; 90 SPK; 18 PAK; 18 PTA; Era 1 (10/90-6/95); Era 2 (7/95-5/98); Era 3 (6/98-12/99)	In 3 successive eras, rates of acute rejection were 63%, 33%, and 39%, respectively; rates of major infection were 60%, 43%, and 44%, respectively	In 3 successive eras, rates of relaparotomy were 47%, 31%, and 33%, respectively; rates of thrombosis were 20%, 7%, and 6%, respectively. Mean length of stay: 12.5 d	In 3 successive eras, patient survival was 77%, 93%, and 100%, respectively	In 3 successive eras, kidney graft survival was 77%, 93%, and 94%, respectively; pancreas graft survival was 60%, 83%, and 83%, respectively
Università di Pisa, Italy, Boggi et al[17], Retrospective, mean follow-up 21 ± 20 mo	PE 110	10 grafts were lost; 3 acute rejection, 2 chronic rejection, 2 venous thrombosis, 2 deaths, 1 late thrombosis (6 mo). Incidence of pancreas acute rejection was 6%	Relaparotomy rate was 13.6%; Mean length of stay was 26 ± 14 d; One month readmission rate was 13%	98%	Pancreas graft survival was 91%
University of Chicago, Bruce et al[116], Retrospective, mean follow-up 16 mo	PE 70	Pancreas graft losses: Thrombosis (3), acute rejection (5), late duodenal perforation (2)	Total 1st year hospitalization: 37 ± 28 d; Relaparotomy in 14 (70%)	88%	Kidney 78%; Pancreas 79%
Louisiana State University, Zibari et al[23], Retrospective, mean follow-up 25 mo	PE 21	Postoperative Bleeding in 4, wound infections in 4, acute rejection in 9, pancreas graft loss in 2	Mean length of stay was 16 d	100%	Kidney 90%; Pancreas 90%
Wake Forest Baptist Medical Center, Rogers et al[4], Retrospective, mean follow-up 6 ± 3 yr	202; SPK 162, PAK 35, PTA 5; PE 179; SE 23	Thrombosis rate was 8%; acute rejection rate was 28%; major infection rate was 50%	Mean length of stay was 13 d; Relaparotomy rate was 38%	Overall patient survival was 87%; one-year patient survival was 97%	Overall kidney and pancreas graft survival rates are 76% and 65%; death-censored graft survival rates are 84% and 72%, and one year graft survival rates are 94% and 88%, respectively
Monash Medical Centre, Victoria, Australia, Kave et al[118], Retrospective, mean follow-up 2 yr	SB 37; PE 27	Pancreas graft thrombosis rates SB 10.8%, PE 7.4% (P = NS)		Two-year patient survival was SB 94.3% vs PE 96.0%	Two year kidney (SB 89.2% vs PE 85.2%); pancreas (SB 77.9% vs PE 71.4%)

SB: Systemic-bladder; SE: Systemic-enteric; PE: Portal-enteric.

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.

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.