Pancreatic transplantation and subsequent graft surveillance by pancreaticportal-enteric anastomosis and temporary venting jejunostomy

Objective To evaluate portal- enteric (PE) pancreas and kidney transplantat ion with venting jejunostomy (VJ) for its efficacy, safety, and reproducibi lity. Summary Background Data Simultaneous pancreas and kidney transplantation fo r patients with long-standing insulin-dependent diabetes mellitus that prog resses to renal failure has revolutionized their treatment and quality of l ife. A current clinical focus is to refine the technical aspects of this pr ocedure. Simultaneous pancreas and kidney transplantation with PE anastomos is with VJ appears to offer several advantages over bladder drainage. VJ al lows initial decompression of the enteric anastomosis, monitoring of pancre atic function by ostomy amylase, and simple access for endoscopic evaluatio n and biopsy of the allograft. Methods Simultaneous pancreas and kidney transplantation with VJ was perfor med in 21 patients from December 1996 to October 2000 at Willis Knighton/LS U Regional Transplant Center. All patients had long-standing insulin-depend ent diabetes mellitus and subsequent renal failure. They were evaluated at the time of surgery by a multidisciplinary transplant team and monitored fo r numerous factors. including length of hospital stay, immunosuppressive re gimen, and ischemia times. All patients had intermittent visual and biochem ical evaluation of pancreatic secretions monitored by means of the VJ. Results Of the 21 patients, 10 were women and 11 were men. Four patients we re black and 17 were white. The mean age at transplantation was 38 years; a verage human leukocyte antigen (HLA) match was one; and average cold ischem ia time was 12 hours. The median hospital stay was 16 days. Four episodes o f post-operative bleeding requiring exploration occurred in four patients. Postoperative wound infections developed in four patients. There were 12 ep isodes of rejection in nine patients. All patients with suspected acute pan creatic rejection underwent endoscopy by means of the VJ and duodenal biops y for evaluation. Two patients lost pancreatic function subsequent to kidne y failure, one secondary to noncompliance and the other as a result of hemo lytic-uremic syndrome. Patient, kidney, and pancreatic survival rates were 100%, 90%, and 90%, respectively. The mean follow-up period was 25 (range 2 -48) months. Conclusion The authors believe that PE pancreatic drainage with VJ is a mor e physiologic method to perform pancreatic transplantation than bladder dra inage. PE drainage allows rapid diagnosis of acute rejection and anastomoti c leak and provides a simple way to monitor ostomy amylase and transplant d uodenal bleeding, This technique is safe and has minimal associated complic ations.