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©The Author(s) 2016.
World J Transplant. Jun 24, 2016; 6(2): 255-271
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.255
Published online Jun 24, 2016. doi: 10.5500/wjt.v6.i2.255
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% |
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) |
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% |
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 |
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) |
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%) |
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 |
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 |
- Citation: El-Hennawy H, Stratta RJ, Smith F. Exocrine drainage in vascularized pancreas transplantation in the new millennium. World J Transplant 2016; 6(2): 255-271
- URL: https://www.wjgnet.com/2220-3230/full/v6/i2/255.htm
- DOI: https://dx.doi.org/10.5500/wjt.v6.i2.255