Bladder vs enteric drainage in simultaneous pancreas–kidney transplantation

Monroy-Cuadros, Mauricio; Salazar, Anastasio; Yılmaz, Serdar; McLaughlin, Kevin

doi:10.1093/ndt/gfi252

Cited by 44 publications

(35 citation statements)

References 16 publications

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“…The incidence of surgical complications is also similar by type of transplant (SPK compared to solitary pancreas transplantation) [1][2][3] . Leaks from the allograft duodenum have been reported to occur in 5%-20% of bladder-drained and 5%-8% of bowel-drained pancreas transplants [9,[33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][67][68][69][70][71][72][73]80,[91][92][93][94][95] . Increasing experience with enteric exocrine drainage is likewise associated with a decreased rate of technical complications [9,38,80,[96][97][98][99][100][101][102][103] .…”

Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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The history of vascularized pancreas transplantation largely parallels developments in immunosuppression and technical refinements in transplant surgery. From the late-1980s to 1995, most pancreas transplants were whole organ pancreatic grafts with insulin delivery to the iliac vein and diversion of the pancreatic ductal secretions to the urinary bladder (systemic-bladder technique). The advent of bladder drainage revolutionized the safety and improved the success of pancreas transplantation. However, starting in 1995, a seismic change occurred from bladder to bowel exocrine drainage coincident with improvements in immunosuppression, preservation techniques, diagnostic monitoring, general medical care, and the success and frequency of enteric conversion. In the new millennium, pancreas transplants are performed predominantly as pancreatico-duodenal grafts with enteric diversion of the pancreatic ductal secretions coupled with iliac vein provision of insulin (systemic-enteric technique) although the systemic-bladder technique endures as a preferred alternative in selected cases. In the early 1990s, a novel technique of venous drainage into the superior mesenteric vein combined with bowel exocrine diversion (portal-enteric technique) was designed and subsequently refined over the next ≥ 20 years to recreate the natural physiology of the pancreas with firstpass hepatic processing of insulin. Enteric drainage usually refers to jejunal or ileal diversion of the exocrine secretions either with a primary enteric anastomosis or with an additional Roux limb. The portal-enteric technique has spawned a number of newer and revisited techniques of enteric exocrine drainage including duodenal or gastric diversion. Reports in the literature suggest no differences in pancreas transplant outcomes irrespective of type of either venous or exocrine diversion. The purpose of this review is to examine the FIELD OF VISION

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Section: El-hennawy H Et Al Exocrine Drainage In Pancreas Transplantsmentioning

confidence: 99%

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

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“…Los pacientes diabéticos tipo 1 se benefi cian del TSPR, lo que mejora la sobrevida y la calidad de vida. El TSPR ha experimentado cambios que han contribuido a optimizar sus resultados: abocamiento del páncreas al intestino delgado 6,7 ; menores efectos adversos de la inmunosupresión por reducción y eliminación de la terapia esteroidal 8 , incorporación de micofenolato mofetil y tacrolimus 9 , inducción con timoglobulina o alemtuzumab 10 ; determinación periódica de anticuerpos anti HLA y vigilancia frecuente en el riñón trasplantado con biopsia. El programa de TSPR de Clínica Las Condes ha aplicado estas tecnologías y esta comunicación presenta los resultados obtenidos 15 años después del primer TSPR 11 .…”

Section: Discussionunclassified

Trasplante simultáneo de páncreas y riñon en diabetes mellitus tipo 1: Experiencia de un centro en Chile

et al. 2011

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“…9 Enteric drainage is preferable in SPK transplants as fewer urological sequelae are seen and monitoring for pancreatic rejection can be carried out by measuring renal allograft creatinine levels. 3 Opinion varies as to the optimum drainage method for PAK and PTA transplants, although many units still prefer bladder drainage. 9 This clearly means that many new patients have bladder-drained pancreas transplants in addition to the large number of patients still under surveillance as a result of earlier procedures.…”

Section: Discussionmentioning

confidence: 99%

“…2 This was for many reasons: ease of surgical technique, a decreased incidence of intraabdominal infections, the ability to measure allograft function using urinary amylase levels, and accessibility for biopsy with cystoscopic guidance. 3 However, the incidence of urological complications was high in particular with volume depletion and metabolic acidosis secondary to bicarbonate loss in the urine, reflux pancreatitis, cystitis and haematuria. This contributed to significant morbidity and to patient hospitalization.…”

Section: Introductionmentioning

confidence: 99%

Acute Urinary Retention Secondary to a Urethral Calculus in a Bladder-Drained Kidney Pancreas Transplant Patient – a Metallic Clip Nidus

2009

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Urological expertise is usually required for the management of any urological complications of bladder-drained pancreatic allografts whether they are the result of simultaneous pancreas-kidney transplants, pancreas after kidney transplants, or pancreas transplants alone. This study presents a case of urinary retention secondary to prostatic urethra calculus impaction, the nidus of which was found to be metallic staples from the donor duodenal segment of a pancreatic allograft. Knowledge of the pre-transplant benchwork gave a high index of suspicion to the urological sequelae of this case and, in particular, the presence of calculi should suggest a metal clip nidus. We examine the methods of exocrine pancreatic drainage, donor duodenum preparation and case management.

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Bladder vs enteric drainage in simultaneous pancreas–kidney transplantation

Abstract: Compared with BD, perioperative morbidity is not increased by ED, and ED is not associated with increased long-term pancreas graft failure. These data suggest that ED is superior to BD and should be considered as the preferred technique for simultaneous pancreas-kidney transplants.

Cited by 44 publications

References 16 publications

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Trasplante simultáneo de páncreas y riñon en diabetes mellitus tipo 1: Experiencia de un centro en Chile

Acute Urinary Retention Secondary to a Urethral Calculus in a Bladder-Drained Kidney Pancreas Transplant Patient – a Metallic Clip Nidus

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