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 co ntroversial, 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) avoi ds 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) tra nsplanted between February 1988 and June 1996, Results, Five ED and fi ve ED patients experienced early pancreas loss within 3 months after t ransplantation, The mean follow-up of the remaining 61 patients has be en 45.7+/-3.9 and 76.0+/-3.3 months for ED and ED patients, respective ly (P<0.005), Both groups had similar pretransplant demographics, co-m orbidity, and nutritional and immunological status, The incidence of v olume depletion (3.4% vs, 34.3%), acidosis (0% vs, 41.0%), pancreatiti s (3.4% vs, 39.7%) and urinary tract infection (26.7% vs, 71%) was low er in ED patients (P<0,005 vs, ED). Of the ED group, 18.7% required co nversion to ED for intractable complications, Initial length of stay w as equivalent (17.7+/-9 days vs, 18.4+/-10 days) between groups, Howev er, the number of admissions (0.79+/-0.18 vs, 1,38+/-0,14) and in-hosp ital days/patient/year (6,26+/-1,16 vs, 11.46+/-2.12) was less in ED p atients (P<0.05 vs, ED). Actuarial patient and pancreas allograft surv ival up to 4 years after transplant was similar between groups, Conclu sions, Compared with ED, (a) perioperative morbidity is not increased by ED, (b) ED is associated with fewer complications and hospitalizati ons, and (c) ED is not associated with increased long-term pancreas gr aft failure, These data suggest that ED is superior to ED and should b e considered as the preferred technique for simultaneous pancreas-kidn ey transplants.