Long-term pancreas allograft outcome in simultaneous pancreas-kidney transplantation - A comparison of enteric and bladder drainage

Background. The optimal pancreatic exocrine drainage method remains controversial, Bladder drainage (ED) is widely used, but associated with a high incidence of urological complications (acidosis, dehydration, pancreatitis, and urinary tract infection), Enteric drainage (ED) avoids this morbidity, but may be associated with inferior graft survival, Methods. We conducted a retrospective study comparing ED and ED in 71 simultaneous pancreas-kidney transplant recipients (37 ED; 34 ED) transplanted between February 1988 and June 1996, Results, Five ED and five ED patients experienced early pancreas loss within 3 months after transplantation, The mean follow-up of the remaining 61 patients has been 45.7+/-3.9 and 76.0+/-3.3 months for ED and ED patients, respectively (P<0.005), Both groups had similar pretransplant demographics, co-morbidity, and nutritional and immunological status, The incidence of volume depletion (3.4% vs, 34.3%), acidosis (0% vs, 41.0%), pancreatitis (3.4% vs, 39.7%) and urinary tract infection (26.7% vs, 71%) was lower in ED patients (P<0,005 vs, ED). Of the ED group, 18.7% required conversion to ED for intractable complications, Initial length of stay was equivalent (17.7+/-9 days vs, 18.4+/-10 days) between groups, However, the number of admissions (0.79+/-0.18 vs, 1,38+/-0,14) and in-hospital days/patient/year (6,26+/-1,16 vs, 11.46+/-2.12) was less in ED patients (P<0.05 vs, ED). Actuarial patient and pancreas allograft survival up to 4 years after transplant was similar between groups, Conclusions, Compared with ED, (a) perioperative morbidity is not increased by ED, (b) ED is associated with fewer complications and hospitalizations, and (c) ED is not associated with increased long-term pancreas graft failure, These data suggest that ED is superior to ED and should be considered as the preferred technique for simultaneous pancreas-kidney transplants.