Initial Australasian experience with portal‐enteric drainage in simultaneous pancreas–kidney transplantation

Kave, Ben; Yii, Ming Kon; Bell, Roger; Kanellis, John; Scott, David F.; Saunder, Alan

doi:10.1111/j.1445-2197.2009.05083.x

Cited by 4 publications

(8 citation statements)

References 32 publications

(42 reference statements)

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“…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%

“…Pancreas graft losses: Thrombosis (3), acute rejection (5) Overall kidney and pancreas graft survival rates are 76% and 65%; death-censored graft survival rates are 84% and 72%, and one year graft survival rates are 94% and 88%, respectively Monash Medical Centre, Victoria, Australia, Kave et al [118] , Retrospective, mean follow-up 2 yr SB 37; PE 27…”

Section: Pe 70mentioning

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%

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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: Pe 70mentioning

confidence: 99%

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

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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“…Due to the fact that a majority of the included studies were epidemiological studies and analyzed survival with a Kaplan–Meier estimation, meta‐analysis of patient and graft survival was not performed. Twelve articles addressed the long‐term patient and graft survival . The most comprehensive of these was the review by Gruessner and Sutherland , which utilized the International Pancreas Transplant Registry.…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, both provided differing recommendations, as one stated the choice of portal drainage may be suggested (grade of recommendation C) while the other concluded that none of the available data demonstrates a definitive advantage . Since these reviews, multiple additional studies, including long‐term follow‐up to the only randomized control study to address this question to date, have been published . Therefore, there is an important need for a systematic review and meta‐analysis of the literature on portal versus systemic venous drainage in pancreatic transplant.…”

mentioning

confidence: 99%

A comparison of long‐term outcomes of portal versus systemic venous drainage in pancreatic transplantation: a systematic review and meta‐analysis

Oliver

Beidas

Bongu

et al. 2015

Clinical Transplantation

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Pancreas transplantation venous effluent can be drained via the portal vein or the systemic circulation; however, no recommendation exists for the ideal technique. A systematic review of the literature from 1989 through 2014 using PubMed, CINHAL, and Cochrane Library for portal versus systemic venous drainage was undertaken. Only studies on humans and published in English were considered. Measures of glycemic control and total cholesterol were synthesized for meta-analysis utilizing random-effects models. Of 166 articles retrieved, 15 articles were included for meta-analysis. Patient and graft survival were comparable in a large database study as well as in the only randomized control study. No differences in complications were seen when exocrine drainage was enteric for the systemic venous group. Fasting insulin (-34.13 pmol/mL, p < 0.001) was significantly lower within the portal drained group; however, fasting blood glucose levels (-3.4 mg/dL, p = 0.32) and hemoglobin A1C levels (mean difference 0.124%, p = 0.25) were comparable. Total cholesterol levels (-3.62 mg/dL, p = 0.447), as well as other measures of lipids, showed no difference. Based on this systematic review and meta-analysis, there is no evidence of differences in outcomes or metabolic control in patients undergoing pancreatic transplant with portal venous drainage compared to the systemic venous drainage.

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Surgical Complications

Harriman,

Farney,

Troppmann

et al. 2023

Transplantation of the Pancreas

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Initial Australasian experience with portal‐enteric drainage in simultaneous pancreas–kidney transplantation

Abstract: PE drainage is a safe and viable method for pancreas transplantation, which can be performed with excellent outcomes. An increased rate of complications with PE drainage has not been demonstrated in this series.

Cited by 4 publications

References 32 publications

Exocrine drainage in vascularized pancreas transplantation in the new millennium

Exocrine drainage in vascularized pancreas transplantation in the new millennium

A comparison of long‐term outcomes of portal versus systemic venous drainage in pancreatic transplantation: a systematic review and meta‐analysis

Surgical Complications

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