NDT Advance Access originally published online on November 11, 2005
Nephrology Dialysis Transplantation 2006 21(2):483-487; doi:10.1093/ndt/gfi252
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© The Author [2005]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Original Articles: Dialysis and Transplantation
Bladder vs enteric drainage in simultaneous pancreas–kidney transplantation
1 Department of Surgery, Division of Transplantation, and 2 Department of Internal Medicine, Division of Nephrology, University of Calgary, Foothills Medical Centre, Calgary, UK
Correspondence and offprint requests to: Mauricio Monroy-Cuadros, MD, Foothills Medical Centre, Department of Surgery, Division of Transplantation. Email: Mauricio.monroy{at}calgaryhealthregion.ca
Background. As a valid therapeutic option for patients with type 1 diabetes mellitus (IDDM) and secondary diabetic nephropathy, simultaneous pancreas–kidney (SPK) transplantation remains more undeveloped than other solid organ transplantations due to restrictions of surgical techniques, especially modes of exocrine pancreatic secretion. Enteric drainage (ED) has recently been increasingly popular due to the long-term complications with bladder drainage (BD).
Objectives. Compare results of SPK transplants with enteric vs bladder exocrine drainage since the beginning of our experience with this type of transplantation.
Methods. From March 1998 to October 2004, 53 SPK transplants were performed, consisting of 30 with bladder drainage (BD) and 23 with enteric drainage (ED). Induction therapy included antilymphocyte globulin (ALG) or anti-CD25 monoclonal antibody. Maintenance regimen consisted of tacrolimus (TAC)/cyclosporine (CsA), mycophenolate mofetil (MMF) and steroids.
Results. Mean age of recipients was 39±7 in both groups. No anastomosis leakage occurred in either group. Surgical complications were not significantly different between the two groups. Incidence of acute rejection, major infections and cytomegalovirus disease were also similar. However, the BD group was characterized by a slight increase in number of urologic complications, metabolic acidosis and dehydration. The length of initial hospital stay was likewise comparable. All patients with a functional graft no longer required exogenous insulin. BD actuarial patient survival and graft three-year survival were 96 and 86%, respectively. For ED, the respective results were 97 and 91%, respectively.
Conclusion. Compared with BD, perioperative morbidity is not increased by ED, and ED is not associated with increased long-term pancreas graft failure. These data suggest that ED is superior to BD and should be considered as the preferred technique for simultaneous pancreas–kidney transplants.
Keywords: bladder drainage; enteric drainage; exocrine drainage; pancreas–kidney transplantation
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