Allograft pancreatectomy after pancreas transplantation with systemic-bladder versus portal-enteric drainage

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

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

From 1989 to 1997, we performed 159 pancreas transplantations (PTXs), including 117 simultaneous kidney-PTX (SKPT), 25 PTXs alone (PTA), and 17 sequential PTXs after kidney transplantations (PAKT). A total of 73 PTXs were performed with systemic-bladder (S-B) and 86 with portal-enteric (P-E) drainage. The need for allograft pancreatectomy (PCTY) may be considered as an index of technical morbidity after PTX. A total of 37 PCTYs (23%) were performed at a mean of 4.7 months after PTX. Twenty-seven PCTYs were performed within 1 month, 30 (81%) within 3 months, and the remaining seven more than 6 months after PTX. The incidence of PCTY did not differ according to type of transplantation: simultaneous kidney-PTX (SKPT) (23%), PTA (24%). and PAKT (23.5%). Indications for PCTY were thrombosis (23), rejection (9), infection (3), and pancreatitis (2). During the study, a total of 70 pancreas grafts were lost, with PCTY performed in 37 (53%). PCTY was directly related to the timing of graft loss; 77% of grafts lost within 3 months of PTX required PCTY, while 25% of grafts lost after 3 months resulted in PCTY (p < 0.01). The incidence of graft failure resulting in PCTY was similar according to type of transplantation: SKPT (55%), PTA (46%), and PAKT (50%). The incidence of PCTY was also similar according to technique of transplantation: 26% S-B versus 21% P-E, p = NS. However, the incidence of graft failure resulting in PCTY was higher in P-E (69%) versus S-B (43%) (p < 0.05) PTX recipients. Patient and kidney graft survival and pancreas retransplant graft survival rates were higher in PTX recipients with P-E drainage. Conclusions: PCTY is performed in over half of cases of pancreas allograft loss and is directly related to the timing and cause of graft loss. The incidence of PCTY is neither related to the type nor technique of PTX. The lower overall incidence of graft loss after PTX with P-E drainage is offset by a higher incidence of PCTY in these grafts that fail. These results suggest that whole-organ PTX with P-E drainage does not place the patient at an increased risk for PCTY and does not preclude successful pancreas retransplantation.

Original languageEnglish (US)
Pages (from-to)465-472
Number of pages8
JournalClinical Transplantation
Volume13
Issue number6
DOIs
StatePublished - 1999
Externally publishedYes

Fingerprint

Pancreas Transplantation
Pancreatectomy
Allografts
Drainage
Urinary Bladder
Transplants
Kidney Transplantation
Incidence
Pancreas
Graft Survival
Kidney
Pancreatitis

Keywords

  • Pancreas transplantation
  • Pancreatectomy
  • Portal-enteric drainage
  • Rejection
  • Surgical complications
  • Systemic-bladder drainage
  • Thrombosis

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Allograft pancreatectomy after pancreas transplantation with systemic-bladder versus portal-enteric drainage. / Stratta, Robert J.; Gaber, A. Osama; Shokouh-Amiri, M. Hosein; Reddy, Kunam Sudhakar; Egidi, M. Francesca; Grewal, Hani P.

In: Clinical Transplantation, Vol. 13, No. 6, 1999, p. 465-472.

Research output: Contribution to journalArticle

Stratta, Robert J. ; Gaber, A. Osama ; Shokouh-Amiri, M. Hosein ; Reddy, Kunam Sudhakar ; Egidi, M. Francesca ; Grewal, Hani P. / Allograft pancreatectomy after pancreas transplantation with systemic-bladder versus portal-enteric drainage. In: Clinical Transplantation. 1999 ; Vol. 13, No. 6. pp. 465-472.
@article{3401e44cd0ec4308b1eff95992ef3208,
title = "Allograft pancreatectomy after pancreas transplantation with systemic-bladder versus portal-enteric drainage",
abstract = "From 1989 to 1997, we performed 159 pancreas transplantations (PTXs), including 117 simultaneous kidney-PTX (SKPT), 25 PTXs alone (PTA), and 17 sequential PTXs after kidney transplantations (PAKT). A total of 73 PTXs were performed with systemic-bladder (S-B) and 86 with portal-enteric (P-E) drainage. The need for allograft pancreatectomy (PCTY) may be considered as an index of technical morbidity after PTX. A total of 37 PCTYs (23{\%}) were performed at a mean of 4.7 months after PTX. Twenty-seven PCTYs were performed within 1 month, 30 (81{\%}) within 3 months, and the remaining seven more than 6 months after PTX. The incidence of PCTY did not differ according to type of transplantation: simultaneous kidney-PTX (SKPT) (23{\%}), PTA (24{\%}). and PAKT (23.5{\%}). Indications for PCTY were thrombosis (23), rejection (9), infection (3), and pancreatitis (2). During the study, a total of 70 pancreas grafts were lost, with PCTY performed in 37 (53{\%}). PCTY was directly related to the timing of graft loss; 77{\%} of grafts lost within 3 months of PTX required PCTY, while 25{\%} of grafts lost after 3 months resulted in PCTY (p < 0.01). The incidence of graft failure resulting in PCTY was similar according to type of transplantation: SKPT (55{\%}), PTA (46{\%}), and PAKT (50{\%}). The incidence of PCTY was also similar according to technique of transplantation: 26{\%} S-B versus 21{\%} P-E, p = NS. However, the incidence of graft failure resulting in PCTY was higher in P-E (69{\%}) versus S-B (43{\%}) (p < 0.05) PTX recipients. Patient and kidney graft survival and pancreas retransplant graft survival rates were higher in PTX recipients with P-E drainage. Conclusions: PCTY is performed in over half of cases of pancreas allograft loss and is directly related to the timing and cause of graft loss. The incidence of PCTY is neither related to the type nor technique of PTX. The lower overall incidence of graft loss after PTX with P-E drainage is offset by a higher incidence of PCTY in these grafts that fail. These results suggest that whole-organ PTX with P-E drainage does not place the patient at an increased risk for PCTY and does not preclude successful pancreas retransplantation.",
keywords = "Pancreas transplantation, Pancreatectomy, Portal-enteric drainage, Rejection, Surgical complications, Systemic-bladder drainage, Thrombosis",
author = "Stratta, {Robert J.} and Gaber, {A. Osama} and Shokouh-Amiri, {M. Hosein} and Reddy, {Kunam Sudhakar} and Egidi, {M. Francesca} and Grewal, {Hani P.}",
year = "1999",
doi = "10.1034/j.1399-0012.1999.130605.x",
language = "English (US)",
volume = "13",
pages = "465--472",
journal = "Clinical Transplantation",
issn = "0902-0063",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Allograft pancreatectomy after pancreas transplantation with systemic-bladder versus portal-enteric drainage

AU - Stratta, Robert J.

AU - Gaber, A. Osama

AU - Shokouh-Amiri, M. Hosein

AU - Reddy, Kunam Sudhakar

AU - Egidi, M. Francesca

AU - Grewal, Hani P.

PY - 1999

Y1 - 1999

N2 - From 1989 to 1997, we performed 159 pancreas transplantations (PTXs), including 117 simultaneous kidney-PTX (SKPT), 25 PTXs alone (PTA), and 17 sequential PTXs after kidney transplantations (PAKT). A total of 73 PTXs were performed with systemic-bladder (S-B) and 86 with portal-enteric (P-E) drainage. The need for allograft pancreatectomy (PCTY) may be considered as an index of technical morbidity after PTX. A total of 37 PCTYs (23%) were performed at a mean of 4.7 months after PTX. Twenty-seven PCTYs were performed within 1 month, 30 (81%) within 3 months, and the remaining seven more than 6 months after PTX. The incidence of PCTY did not differ according to type of transplantation: simultaneous kidney-PTX (SKPT) (23%), PTA (24%). and PAKT (23.5%). Indications for PCTY were thrombosis (23), rejection (9), infection (3), and pancreatitis (2). During the study, a total of 70 pancreas grafts were lost, with PCTY performed in 37 (53%). PCTY was directly related to the timing of graft loss; 77% of grafts lost within 3 months of PTX required PCTY, while 25% of grafts lost after 3 months resulted in PCTY (p < 0.01). The incidence of graft failure resulting in PCTY was similar according to type of transplantation: SKPT (55%), PTA (46%), and PAKT (50%). The incidence of PCTY was also similar according to technique of transplantation: 26% S-B versus 21% P-E, p = NS. However, the incidence of graft failure resulting in PCTY was higher in P-E (69%) versus S-B (43%) (p < 0.05) PTX recipients. Patient and kidney graft survival and pancreas retransplant graft survival rates were higher in PTX recipients with P-E drainage. Conclusions: PCTY is performed in over half of cases of pancreas allograft loss and is directly related to the timing and cause of graft loss. The incidence of PCTY is neither related to the type nor technique of PTX. The lower overall incidence of graft loss after PTX with P-E drainage is offset by a higher incidence of PCTY in these grafts that fail. These results suggest that whole-organ PTX with P-E drainage does not place the patient at an increased risk for PCTY and does not preclude successful pancreas retransplantation.

AB - From 1989 to 1997, we performed 159 pancreas transplantations (PTXs), including 117 simultaneous kidney-PTX (SKPT), 25 PTXs alone (PTA), and 17 sequential PTXs after kidney transplantations (PAKT). A total of 73 PTXs were performed with systemic-bladder (S-B) and 86 with portal-enteric (P-E) drainage. The need for allograft pancreatectomy (PCTY) may be considered as an index of technical morbidity after PTX. A total of 37 PCTYs (23%) were performed at a mean of 4.7 months after PTX. Twenty-seven PCTYs were performed within 1 month, 30 (81%) within 3 months, and the remaining seven more than 6 months after PTX. The incidence of PCTY did not differ according to type of transplantation: simultaneous kidney-PTX (SKPT) (23%), PTA (24%). and PAKT (23.5%). Indications for PCTY were thrombosis (23), rejection (9), infection (3), and pancreatitis (2). During the study, a total of 70 pancreas grafts were lost, with PCTY performed in 37 (53%). PCTY was directly related to the timing of graft loss; 77% of grafts lost within 3 months of PTX required PCTY, while 25% of grafts lost after 3 months resulted in PCTY (p < 0.01). The incidence of graft failure resulting in PCTY was similar according to type of transplantation: SKPT (55%), PTA (46%), and PAKT (50%). The incidence of PCTY was also similar according to technique of transplantation: 26% S-B versus 21% P-E, p = NS. However, the incidence of graft failure resulting in PCTY was higher in P-E (69%) versus S-B (43%) (p < 0.05) PTX recipients. Patient and kidney graft survival and pancreas retransplant graft survival rates were higher in PTX recipients with P-E drainage. Conclusions: PCTY is performed in over half of cases of pancreas allograft loss and is directly related to the timing and cause of graft loss. The incidence of PCTY is neither related to the type nor technique of PTX. The lower overall incidence of graft loss after PTX with P-E drainage is offset by a higher incidence of PCTY in these grafts that fail. These results suggest that whole-organ PTX with P-E drainage does not place the patient at an increased risk for PCTY and does not preclude successful pancreas retransplantation.

KW - Pancreas transplantation

KW - Pancreatectomy

KW - Portal-enteric drainage

KW - Rejection

KW - Surgical complications

KW - Systemic-bladder drainage

KW - Thrombosis

UR - http://www.scopus.com/inward/record.url?scp=0033460190&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033460190&partnerID=8YFLogxK

U2 - 10.1034/j.1399-0012.1999.130605.x

DO - 10.1034/j.1399-0012.1999.130605.x

M3 - Article

C2 - 10617235

AN - SCOPUS:0033460190

VL - 13

SP - 465

EP - 472

JO - Clinical Transplantation

JF - Clinical Transplantation

SN - 0902-0063

IS - 6

ER -