MANAGEMENT OF EXOCRINE PANCREATIC-SECRETION - CENTRAL PROBLEM OF HETEROLOGOUS PANCREAS TRANSPLANTATION

In a consecutive series of 47 pancreatic transplantations, the duct oc clusion technique and the bladder drainage technique are evaluated. Ma jor problems, when using the duct occlusion technique are pancreatic f istulae with secondary infections and bleedings. Early postoperative g raft thrombosis remains a crucial problem. Finally, graft rejection ca n not be diagnosed in time when using the duct occlusion technique. In contrast, the bladder drainage technique guarantees an absolutely saf e management of the exocrine pancreas secretion. The risk of early pos toperative graft thromboses reaches nearly zero. In addition, by monit oring urinary amylase and thereby the function of the exocrine pancrea s, rejection episodes can be diagnosed very early. Early postoperative graft pancreatitis of the bladder drained pancreatic allografts remai ns a significant problem. In addition due to excessive bicarbonate los s via the urine oral bicarbonate substitution is necessary. A high inc idence of urinary tract infections as well as unspecific irritations o f the urinary tract are further drawbacks of the bladder drainage tech nique. They can be managed, however, relatively easily. Since using th e bladder drainage technique, 1-year-graft-function rate of the pancre atic allografts increased by more than 40 % and reaches now 88%. The n ew operative technique represents the best surgical procedure for cont rol of the exocrine secretion of pancreatic allografts at the moment. Simultaneous pancreas-/kidney transplantation in the technique describ ed can therefore be recommended a selected group of type-I diabetics w ith end-stage renal disease as the therapy of choice.