Pancreas transplant results according to the technique of duct management: Bladder versus enteric drainage

Mikel Prieto, David E R Sutherland, Frederick C. Goetz, Mark E. Rosenberg, John S. Najarian

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Between July 1978 and February 1987, 177 pancreas transplants were performed. The 1-year patient and graft survival rates for the first 100 transplants up to October 1984 were 88% and 27%, respectively. Since November 1984, duct drainage has been used for 74 of 77 transplants, bladder (BD) in 36 and enteric (ED) in 38, with 1-year patient survival rates of 89% and 92%, respectively, and graft survival rates of 58% and 42%. The technical failure rate was similar in both groups (31%). Immunosuppression was with antilymphocyte globulin, cyclosporine, azathioprine, and prednisone. Most recipients were nonuremic, without kidney transplants, and 1-year graft survival rates were 69% for BD (n = 21) and 42% for ED (n = 29). The diagnosis of rejection was based on a decline in urine amylase activity in the BD and on an increase in plasma glucose alone in the ED group. For technically successful (TS) grafts, the number of rejection episodes reversed per number diagnosed was 23 of 26 (18 patients) in BD (88%) and six of 15 (14 patients) (40%) in ED (p < 0.05). The advantage of BD with monitoring of urine amylase activity is seen in TS cases; 1-year cadaveric graft survival rates were 90% for BD (n = 23) versus 47% for ED (n = 15) (p = 0.05). In recipients of segmental transplants with ED from living-related donors, 1-year graft survival rates were 57% overall (n = 18) and 88% for TS cases (n = 12), which is identical to cadaveric BD cases. A disadvantage of BD was metabolic acidosis induced by chronic bicarbonate loss in the urine from the pancreas graft. Nevertheless, we conclude that BD is the preferred technique for pancreas transplants from cadaver donors because of the ability to monitor exocrine and endocrine function continuously, thus leading to early diagnosis and treatment of rejection episodes.

Original languageEnglish (US)
Pages (from-to)680-691
Number of pages12
JournalSurgery
Volume102
Issue number4
StatePublished - 1987
Externally publishedYes

Fingerprint

Drainage
Pancreas
Urinary Bladder
Transplants
Graft Survival
Survival Rate
Urine
Amylases
Antilymphocyte Serum
Living Donors
Azathioprine
Graft Rejection
Bicarbonates
Prednisone
Acidosis
Cadaver
Immunosuppression
Cyclosporine
Early Diagnosis
Tissue Donors

ASJC Scopus subject areas

  • Surgery

Cite this

Prieto, M., Sutherland, D. E. R., Goetz, F. C., Rosenberg, M. E., & Najarian, J. S. (1987). Pancreas transplant results according to the technique of duct management: Bladder versus enteric drainage. Surgery, 102(4), 680-691.

Pancreas transplant results according to the technique of duct management : Bladder versus enteric drainage. / Prieto, Mikel; Sutherland, David E R; Goetz, Frederick C.; Rosenberg, Mark E.; Najarian, John S.

In: Surgery, Vol. 102, No. 4, 1987, p. 680-691.

Research output: Contribution to journalArticle

Prieto, M, Sutherland, DER, Goetz, FC, Rosenberg, ME & Najarian, JS 1987, 'Pancreas transplant results according to the technique of duct management: Bladder versus enteric drainage', Surgery, vol. 102, no. 4, pp. 680-691.
Prieto M, Sutherland DER, Goetz FC, Rosenberg ME, Najarian JS. Pancreas transplant results according to the technique of duct management: Bladder versus enteric drainage. Surgery. 1987;102(4):680-691.
Prieto, Mikel ; Sutherland, David E R ; Goetz, Frederick C. ; Rosenberg, Mark E. ; Najarian, John S. / Pancreas transplant results according to the technique of duct management : Bladder versus enteric drainage. In: Surgery. 1987 ; Vol. 102, No. 4. pp. 680-691.
@article{05265c43668d4e6da9625dc15dd3eb7f,
title = "Pancreas transplant results according to the technique of duct management: Bladder versus enteric drainage",
abstract = "Between July 1978 and February 1987, 177 pancreas transplants were performed. The 1-year patient and graft survival rates for the first 100 transplants up to October 1984 were 88{\%} and 27{\%}, respectively. Since November 1984, duct drainage has been used for 74 of 77 transplants, bladder (BD) in 36 and enteric (ED) in 38, with 1-year patient survival rates of 89{\%} and 92{\%}, respectively, and graft survival rates of 58{\%} and 42{\%}. The technical failure rate was similar in both groups (31{\%}). Immunosuppression was with antilymphocyte globulin, cyclosporine, azathioprine, and prednisone. Most recipients were nonuremic, without kidney transplants, and 1-year graft survival rates were 69{\%} for BD (n = 21) and 42{\%} for ED (n = 29). The diagnosis of rejection was based on a decline in urine amylase activity in the BD and on an increase in plasma glucose alone in the ED group. For technically successful (TS) grafts, the number of rejection episodes reversed per number diagnosed was 23 of 26 (18 patients) in BD (88{\%}) and six of 15 (14 patients) (40{\%}) in ED (p < 0.05). The advantage of BD with monitoring of urine amylase activity is seen in TS cases; 1-year cadaveric graft survival rates were 90{\%} for BD (n = 23) versus 47{\%} for ED (n = 15) (p = 0.05). In recipients of segmental transplants with ED from living-related donors, 1-year graft survival rates were 57{\%} overall (n = 18) and 88{\%} for TS cases (n = 12), which is identical to cadaveric BD cases. A disadvantage of BD was metabolic acidosis induced by chronic bicarbonate loss in the urine from the pancreas graft. Nevertheless, we conclude that BD is the preferred technique for pancreas transplants from cadaver donors because of the ability to monitor exocrine and endocrine function continuously, thus leading to early diagnosis and treatment of rejection episodes.",
author = "Mikel Prieto and Sutherland, {David E R} and Goetz, {Frederick C.} and Rosenberg, {Mark E.} and Najarian, {John S.}",
year = "1987",
language = "English (US)",
volume = "102",
pages = "680--691",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "4",

}

TY - JOUR

T1 - Pancreas transplant results according to the technique of duct management

T2 - Bladder versus enteric drainage

AU - Prieto, Mikel

AU - Sutherland, David E R

AU - Goetz, Frederick C.

AU - Rosenberg, Mark E.

AU - Najarian, John S.

PY - 1987

Y1 - 1987

N2 - Between July 1978 and February 1987, 177 pancreas transplants were performed. The 1-year patient and graft survival rates for the first 100 transplants up to October 1984 were 88% and 27%, respectively. Since November 1984, duct drainage has been used for 74 of 77 transplants, bladder (BD) in 36 and enteric (ED) in 38, with 1-year patient survival rates of 89% and 92%, respectively, and graft survival rates of 58% and 42%. The technical failure rate was similar in both groups (31%). Immunosuppression was with antilymphocyte globulin, cyclosporine, azathioprine, and prednisone. Most recipients were nonuremic, without kidney transplants, and 1-year graft survival rates were 69% for BD (n = 21) and 42% for ED (n = 29). The diagnosis of rejection was based on a decline in urine amylase activity in the BD and on an increase in plasma glucose alone in the ED group. For technically successful (TS) grafts, the number of rejection episodes reversed per number diagnosed was 23 of 26 (18 patients) in BD (88%) and six of 15 (14 patients) (40%) in ED (p < 0.05). The advantage of BD with monitoring of urine amylase activity is seen in TS cases; 1-year cadaveric graft survival rates were 90% for BD (n = 23) versus 47% for ED (n = 15) (p = 0.05). In recipients of segmental transplants with ED from living-related donors, 1-year graft survival rates were 57% overall (n = 18) and 88% for TS cases (n = 12), which is identical to cadaveric BD cases. A disadvantage of BD was metabolic acidosis induced by chronic bicarbonate loss in the urine from the pancreas graft. Nevertheless, we conclude that BD is the preferred technique for pancreas transplants from cadaver donors because of the ability to monitor exocrine and endocrine function continuously, thus leading to early diagnosis and treatment of rejection episodes.

AB - Between July 1978 and February 1987, 177 pancreas transplants were performed. The 1-year patient and graft survival rates for the first 100 transplants up to October 1984 were 88% and 27%, respectively. Since November 1984, duct drainage has been used for 74 of 77 transplants, bladder (BD) in 36 and enteric (ED) in 38, with 1-year patient survival rates of 89% and 92%, respectively, and graft survival rates of 58% and 42%. The technical failure rate was similar in both groups (31%). Immunosuppression was with antilymphocyte globulin, cyclosporine, azathioprine, and prednisone. Most recipients were nonuremic, without kidney transplants, and 1-year graft survival rates were 69% for BD (n = 21) and 42% for ED (n = 29). The diagnosis of rejection was based on a decline in urine amylase activity in the BD and on an increase in plasma glucose alone in the ED group. For technically successful (TS) grafts, the number of rejection episodes reversed per number diagnosed was 23 of 26 (18 patients) in BD (88%) and six of 15 (14 patients) (40%) in ED (p < 0.05). The advantage of BD with monitoring of urine amylase activity is seen in TS cases; 1-year cadaveric graft survival rates were 90% for BD (n = 23) versus 47% for ED (n = 15) (p = 0.05). In recipients of segmental transplants with ED from living-related donors, 1-year graft survival rates were 57% overall (n = 18) and 88% for TS cases (n = 12), which is identical to cadaveric BD cases. A disadvantage of BD was metabolic acidosis induced by chronic bicarbonate loss in the urine from the pancreas graft. Nevertheless, we conclude that BD is the preferred technique for pancreas transplants from cadaver donors because of the ability to monitor exocrine and endocrine function continuously, thus leading to early diagnosis and treatment of rejection episodes.

UR - http://www.scopus.com/inward/record.url?scp=0023610170&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0023610170&partnerID=8YFLogxK

M3 - Article

C2 - 3310300

AN - SCOPUS:0023610170

VL - 102

SP - 680

EP - 691

JO - Surgery (United States)

JF - Surgery (United States)

SN - 0039-6060

IS - 4

ER -