A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation

Robert J. Stratta, A. Osama Gaber, M. Hosein Shokouh-Amiri, Kunam Sudhakar Reddy, M. Francesca Egidi, Hani P. Grewal, Lillian W. Gaber

Research output: Contribution to journalArticle

78 Citations (Scopus)

Abstract

Background. Most pancreas transplants are performed with systemic venous delivery of insulin and bladder drainage of the exocrine secretions (systemic-bladder [S-B]). To develop a more physiologic procedure, we performed pancreas transplantations with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric [P-E]). Methods. During an 11-month period, we prospectively alternated 32 consecutive pancreas transplant recipients to either S-B (n = 16) or P-E (n = 16) drainage with standardized immunosuppression. Results. Patient, kidney, and pancreas graft survival rates after simultaneous kidney-pancreas transplantation were 91% S-B versus 92% P-E, 91% S-B versus 92% P-E, and 82% S-B versus 92% P-E, respectively. Pancreas graft survival rates after solitary pancreas transplantation were 80% S-B versus 75% P-E. There were no graft losses either to immunologic or infectious complications in either group, but the incidence of acute rejection was slightly higher in the S-B group (44% S-B vs 31% P-E, P = NS). The cost and length of the initial hospital stay were similar between groups. The incidence of operative complications, major infections, and cytomegalovirus infections were likewise comparable. However, the S-B group was characterized by a slight increase in the number of readmissions, urinary tract infections, and urologic complications. Furthermore, metabolic acidosis and dehydration were more common in the S-B group. Conclusions. Pancreas transplantation with P-E drainage can be performed with short-term results comparable to those of transplantation with S-B drainage.

Original languageEnglish (US)
Pages (from-to)217-226
Number of pages10
JournalSurgery
Volume127
Issue number2
StatePublished - 2000
Externally publishedYes

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Pancreas Transplantation
Drainage
Urinary Bladder
Pancreas
Graft Survival
Survival Rate
Insulin
Transplants
Incidence
Cytomegalovirus Infections
Acidosis
Dehydration
Urinary Tract Infections
Kidney Transplantation
Immunosuppression
Length of Stay

ASJC Scopus subject areas

  • Surgery

Cite this

Stratta, R. J., Gaber, A. O., Shokouh-Amiri, M. H., Reddy, K. S., Egidi, M. F., Grewal, H. P., & Gaber, L. W. (2000). A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation. Surgery, 127(2), 217-226.

A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation. / Stratta, Robert J.; Gaber, A. Osama; Shokouh-Amiri, M. Hosein; Reddy, Kunam Sudhakar; Egidi, M. Francesca; Grewal, Hani P.; Gaber, Lillian W.

In: Surgery, Vol. 127, No. 2, 2000, p. 217-226.

Research output: Contribution to journalArticle

Stratta, RJ, Gaber, AO, Shokouh-Amiri, MH, Reddy, KS, Egidi, MF, Grewal, HP & Gaber, LW 2000, 'A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation', Surgery, vol. 127, no. 2, pp. 217-226.
Stratta RJ, Gaber AO, Shokouh-Amiri MH, Reddy KS, Egidi MF, Grewal HP et al. A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation. Surgery. 2000;127(2):217-226.
Stratta, Robert J. ; Gaber, A. Osama ; Shokouh-Amiri, M. Hosein ; Reddy, Kunam Sudhakar ; Egidi, M. Francesca ; Grewal, Hani P. ; Gaber, Lillian W. / A prospective comparison of systemic-bladder versus portal-enteric drainage in vascularized pancreas transplantation. In: Surgery. 2000 ; Vol. 127, No. 2. pp. 217-226.
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abstract = "Background. Most pancreas transplants are performed with systemic venous delivery of insulin and bladder drainage of the exocrine secretions (systemic-bladder [S-B]). To develop a more physiologic procedure, we performed pancreas transplantations with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric [P-E]). Methods. During an 11-month period, we prospectively alternated 32 consecutive pancreas transplant recipients to either S-B (n = 16) or P-E (n = 16) drainage with standardized immunosuppression. Results. Patient, kidney, and pancreas graft survival rates after simultaneous kidney-pancreas transplantation were 91{\%} S-B versus 92{\%} P-E, 91{\%} S-B versus 92{\%} P-E, and 82{\%} S-B versus 92{\%} P-E, respectively. Pancreas graft survival rates after solitary pancreas transplantation were 80{\%} S-B versus 75{\%} P-E. There were no graft losses either to immunologic or infectious complications in either group, but the incidence of acute rejection was slightly higher in the S-B group (44{\%} S-B vs 31{\%} P-E, P = NS). The cost and length of the initial hospital stay were similar between groups. The incidence of operative complications, major infections, and cytomegalovirus infections were likewise comparable. However, the S-B group was characterized by a slight increase in the number of readmissions, urinary tract infections, and urologic complications. Furthermore, metabolic acidosis and dehydration were more common in the S-B group. Conclusions. Pancreas transplantation with P-E drainage can be performed with short-term results comparable to those of transplantation with S-B drainage.",
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AU - Shokouh-Amiri, M. Hosein

AU - Reddy, Kunam Sudhakar

AU - Egidi, M. Francesca

AU - Grewal, Hani P.

AU - Gaber, Lillian W.

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N2 - Background. Most pancreas transplants are performed with systemic venous delivery of insulin and bladder drainage of the exocrine secretions (systemic-bladder [S-B]). To develop a more physiologic procedure, we performed pancreas transplantations with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric [P-E]). Methods. During an 11-month period, we prospectively alternated 32 consecutive pancreas transplant recipients to either S-B (n = 16) or P-E (n = 16) drainage with standardized immunosuppression. Results. Patient, kidney, and pancreas graft survival rates after simultaneous kidney-pancreas transplantation were 91% S-B versus 92% P-E, 91% S-B versus 92% P-E, and 82% S-B versus 92% P-E, respectively. Pancreas graft survival rates after solitary pancreas transplantation were 80% S-B versus 75% P-E. There were no graft losses either to immunologic or infectious complications in either group, but the incidence of acute rejection was slightly higher in the S-B group (44% S-B vs 31% P-E, P = NS). The cost and length of the initial hospital stay were similar between groups. The incidence of operative complications, major infections, and cytomegalovirus infections were likewise comparable. However, the S-B group was characterized by a slight increase in the number of readmissions, urinary tract infections, and urologic complications. Furthermore, metabolic acidosis and dehydration were more common in the S-B group. Conclusions. Pancreas transplantation with P-E drainage can be performed with short-term results comparable to those of transplantation with S-B drainage.

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