Effects of Portal Versus Systemic Venous Drainage in Pancreas and Kidney-Pancreas Transplantation

Alonso, A.; Fernández, Constantino; Cillero, Sonia; Gómez, Manuel; Aguirrezabalaga, J.; Valdés, F

doi:10.1016/j.transproceed.2007.06.065

Cited by 12 publications

(19 citation statements)

References 8 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%

“…However, in most cases, "portal venous" drainage usually infers that the allograft has a vertical orientation with the body and tail directed towards the pelvis, the head and duodenum directed cephalad, and the recipient SMV as the site for the venous anastomosis [18][19][20][21][22] (Figure 4). The bowel anastomosis is most commonly performed to a bowel loop that is not excluded from the transit of intestinal contents [4,16,17,33,[39][40][41][42][44][45][46][49][50][51][52][53][112][113][114][115][116][117][118][119][120][121] . Alternatively, the allograft duodenum can be connected directly into the native stomach or duodenum, to a diverting Roux limb without or with a venting jejunostomy, or to an omega loop [23][24][25][26][27][28][29][30][31][32]122] (Table 7).…”

Section: Bowel Drainage Of the Pancreatic Ductal Secretions (Portal-ementioning

confidence: 99%

“…The stapled and divided proximal limb can then be placed 40 cm or more distal to the anastomosis on the efferent limb and the second [49] and Quintela et al [51] , …”

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

confidence: 99%

“…However, neither large registry analyses nor prospective cohort studies have been able to corroborate these purported benefits (Table 9) [1,33,[39][40][41][42][44][45][46][49][50][51][52][53][112][113][114][115][116][117][118][119][120][121][122][123] . Conversely, when comparing the three major techniques of pancreas transplantation, there are likewise no well controlled studies to suggest any major drawbacks of portal-enteric vs either systemic-bladder or systemic-enteric drainage.…”

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

confidence: 99%

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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%

Section: Bowel Drainage Of the Pancreatic Ductal Secretions (Portal-ementioning

confidence: 99%

“…The stapled and divided proximal limb can then be placed 40 cm or more distal to the anastomosis on the efferent limb and the second [49] and Quintela et al [51] , …”

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

confidence: 99%

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

confidence: 99%

See 2 more Smart Citations

Exocrine drainage in vascularized pancreas transplantation in the new millennium

El‐Hennawy¹,

Stratta²,

Smith³

2016

WJT

View full text Add to dashboard Cite

show abstract

“…Conversely, portal venous drainage directs secreted insulin to the liver in a more physiologic manner. Despite this theoretic advantage, several studies have failed to show differences in graft survival [26][27][28][29], fasting glucose [ 26 , 28 , 29 ], or lipid metabolism [ 28 , 29 ], and systemic drainage has remained the more commonly performed procedure [ 30 ]. This issue is particularly important because the heterotopic allograft pancreas is denervated and thus devoid of autonomic nervous system control while still under the modulatory infl uences of humoral factors, such as incretins.…”

Section: Peripheral Hyperinsulinemiamentioning

confidence: 99%

Hypoglycemia following pancreas transplantation

Shen¹,

Gaglia

2008

Curr Diab Rep

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Mild symptoms of hypoglycemia in individuals with type 1 diabetes who have undergone pancreas transplantation are common, but biochemical evidence of hypoglycemia in these individuals often remains scant. Rarely, more overt cases with profound neuroglycopenic symptoms and documented hypoglycemia after transplantation have been described. Although the diagnosis of hypoglycemia in most cases of adrenergic symptoms alone, without documented hypoglycemia, remains questionable and likely not clinically significant, several potential etiologies have been identified in the more severe cases. This article reports a case with severe hypoglycemia after pancreas transplantation for type 1 diabetes, reviews several potential mechanisms underlying pancreas allograft-associated hypoglycemia, and discusses current treatment strategies for minimizing symptomatic hypoglycemia after transplant.

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Standard Open Procedures from Deceased Donors

Gruessner

2023

Transplantation of the Pancreas

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Effects of Portal Versus Systemic Venous Drainage in Pancreas and Kidney-Pancreas Transplantation

Cited by 12 publications

References 8 publications

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Hypoglycemia following pancreas transplantation

Standard Open Procedures from Deceased Donors

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