PRIMARY ENTERIC DRAINAGE OF THE PANCREAS ALLOGRAFT REVISITED

Background: Historically, primary enteric drainage (ED) of exocrine se cretions in pancreas allografts was associated with a poor outcome, mo stly as a result of infectious complications. On the other hand, bladd er drainage (ED), which is presently used in the majority of instituti ons, is associated with substantial urologic morbidity. The aim of thi s study is to reassess the role of primary ED by reviewing our experie nce with ED versus. ED in simultaneous pancreas-kidney transplantation s. Study Design: The records of all pancreas-kidney transplantations p erformed between October 1990 and September 1996 were reviewed (n = 42 ). Enteric drainage was used in the last 16 (38%) and ED in the first 26 (62%). The ED and ED groups were comparable with respect to donor a nd recipient characteristics. Results: Length of stay for the transpla ntation (mean +/- standard deviation) was significantly shorter with E D than with ED (12.9 +/- 5.6 versus 20.4 +/- 9.6 days, p = 0.007). The total number of readmissions (1.7 +/- 1.5 versus 1.2 +/- 1.2 days, p = 0.2) and the length of hospital stay in the first 6 months after dis charge (13.7 +/- 16.2 versus 10 +/- 11.3 days, p = 0.4) were similar b etween ED and ED. Complications requiring admission were distributed a s follows in ED and ED recipients: recurrent/persistent urinary compli cations (46% versus 6%, p = 0.01), dehydration (27% versus 6%, p = 0.0 5), symptomatic graft pancreatitis: (8% versus 6%, p = 0.9), gastroint estinal disturbance (27% versus 12%, p = 0.1), and wound infection (12 % versus 19%, p = 0.5). The duration of the operative procedure was sh orter in ED than in ED (4.3 +/- 0.9 versus 5.4 +/- 0.8 hours, p = 0.01 ). Reoperation during the initial transplantation stay was necessary i n 23% of the patients having ED, compared with none having ED (p = 0.0 4). Similarly, fewer ED patients underwent reoperations compared with ED patients in the first 6 months after discharge (38% versus 69%, p = 0.04). Hospital charges for ED were lower than for ED for the initial admission ($73,458 +/- 17,103 versus $107,193 +/- 32,965, p = 0.001). Actuarial patient (96% versus 94%, p = 0.6), kidney (85% versus 87%, p = 0.9), and technically successful pancreas (90% versus 85%, p = 0.6 ) survival rates at 1 year were similar for ED and ED. Conclusions: Ou r results indicate that, compared with ED, ED is associated with less morbidity and shorter hospitalization without compromising-outcome. Pr imary ED is a viable alternative to ED in simultaneous pancreas-kidney transplantation. More clinical experience with careful cost-effective ness analysis is needed to better assess the implications of primary E D. U Am Cell Surg 1997;185:471-475. (C) 1997 by the American College o f Surgeons).