Allograft pancreatectomy after pancreas transplantation with systemic-bladder versus portal-enteric drainage

From 1989 to 1997, we performed 159 pancreas transplantations (PTXs), inclu ding 117 simultaneous kidney-PTX (SKPT), 25 PTXs alone (PTA), and 17 sequen tial PTXs after kidney transplantations (PAKT). A total of 73 PTXs were per formed with systemic-bladder (S-B) and 86 with portal-enteric (P-E) drainag e. The need for allograft pancreatectomy (PCTY) may be considered as an ind ex of technical morbidity after PTX. A total of 37 PCTYs (23%) were perform ed at a mean of 4.7 months after PTX. Twenty-seven PCTYs were performed wit hin 1 month, 30 (81%) within 3 months, and the remaining seven more than 6 months after PTX. The incidence of PCTY did not differ according to type of transplantation: simultaneous kidney-PTX (SKPT) (23%), PTA (24%), and PAKT (23.5%). Indications for PCTY were thrombosis (23), rejection (9), infecti on (3), and pancreatitis (2). During the study, a total of 70 pancreas graf ts were lost, with PCTY performed in 37 (53%). PCTY was directly related to the timing of graft loss; 77% of grafts lost within 3 months of PTX requir ed PCTY, while 25% of grafts lost after 3 months resulted in PCTY (p < 0.01 ). The incidence of graft failure resulting in PCTY was similar according t o type of transplantation: SKPT (55%), PTA (46%), and PAKT (50%). The incid ence of PCTY was also similar according to technique of transplantation: 26 % S-B versus 21% P-E, p = NS. However, the incidence of graft failure resul ting in PCTY was higher in P-E (69%) versus S-B (43%) (p < 0.05) PTX recipi ents. Patient and kidney graft survival and pancreas retransplant graft sur vival rates were higher in PTX recipients with P-E drainage. Conclusions: PCTY is performed in over half of cases of pancreas allograft loss and is directly related to the timing and cause of graft loss. The inc idence of PCTY is neither related to the type nor technique of PTX. The low er overall incidence of graft loss after PTX with P-E drainage is offset by a higher incidence of PCTY in these grafts that fail. These results sugges t that whole-organ PTX with P-E drainage does not place the patient at an i ncreased risk for PCTY and does not preclude successful pancreas retranspla ntation.