Premium
Pancreas transplantation: advantages of both enteric and bladder drainage combined in a two‐step approach
Author(s) -
Van De Linde Pieter,
Van Der Boog Paul J.M.,
Baranski Andrzej G.,
De Fijter Johan W.,
Ringers Jan,
Schaapherder Alexander F.M.
Publication year - 2006
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/j.1399-0012.2005.00477.x
Subject(s) - medicine , pancreas transplantation , transplantation , surgery , pancreas , urinary system , complication , pancreatitis , kidney transplantation , urology
Background: Although there is a tendency to perform enteric drainage of pancreas transplants in simultaneous pancreas–kidney (SPK) transplantation, bladder drainage is still preferable in pancreas transplantation alone (PTA) or after a previous kidney transplantation (PAK). Our hypothesis was that enteric conversion of a bladder drained pancreas is an effective and safe procedure. We studied the complication rate and physiological effects of enteric conversion in patients with primary bladder‐drained SPK transplantation. Patients: We performed 51 enteric conversions in bladder‐drained SPK transplant recipients. As we observed a low complication rate, with time enteric conversions were also performed for less strict and severe indications. Results: The main indications for conversion were urological problems, metabolic complications and reflux‐pancreatitis. The median transplantation–conversion interval was 12 months (range 2–40 months). Post‐operative complications consisted of seven urinary tract infections, two low‐grade superficial wound infections, one minor bleeding, one phlebitis and one paralytic ileus. In two patients, a relaparotomy was necessary. No graft rejection following enteric conversion was found. Long‐term renal and pancreatic function were not affected by the enteric conversion. Three‐year patient, kidney and pancreas survival rates after enteric conversion were 93, 97 and 93%, respectively (censored data). Conclusion: Enteric conversion after pancreas transplantation is an effective and safe procedure. Therefore, we suggest a policy of a two‐step approach of primary bladder drainage followed by an enteric conversion of the pancreas in a selected group of SPK patients.