A prospective comparison of simultaneous kidney-pancreas transplantation with systemic-enteric versus portal-enteric drainage

Objective To compare pancreas transplantation with systemic-enteric (SE) versus porta l-enteric (PE) drainage in a prospective fashion. Summary Background Data To improve the physiology of pancreas transplantation, the authors develope d a new technique of portal venous delivery of insulin and enteric drainage of the exocrine secretions. Methods During a 26-month period, the authors prospectively alternated 54 consecuti ve simultaneous kidney and pancreas transplants to either SE (n = 27) or PE (n = 27) drainage. The two groups were well matched for numerous character istics. Maintenance immunosuppression in both groups consisted tacrolimus, mycophenolate mofetil, and steroids. Results Patient survival rates were 93% SE versus 96% PE; kidney graft surv ival rates were 93% in both groups. Pancreas trans plantation survival (com plete insulin independence) was 74% after SE versus 85% after PE drainage w ith a mean follow-up of 17 months. The mean length of initial hospital stay was 12.4 days in the SE group and 12.8 days in the PE group. The SE group was characterized by a slight increase in the number of readmissions. The i ncidences of acute rejection (33%) and major infection (52%) were similar i n both groups. The incidence of intraabdominal infection was slightly highe r in the SE group. However, the early relaparotomy rate was similar between groups. The composite endpoint of no rejection, graft loss, or death was a ttained in 56% of SE versus 59% of PE patients. Conclusions These results suggest that simultaneous kidney and pancreas tra nsplantation with SE or PE drainage can be performed with comparable short- term outcomes.