膵臓疾患と治療
オープンアクセス

概要

Pancreas Transplantation with Systemic-Enteric Drainage when Portal-Enteric Drainage is Contraindicated

 Stratta RJ*, Farney AC, Orlando G, Farooq U, Al-Shraideh Y, El-Hennawy H and Rogers J

Aim: Although most Pancreas Transplants (PTs) are currently performed with exocrine enteric drainage, <20% also incorporate portal venous delivery of insulin (portal-enteric drainage). The purpose of this study was to analyze outcomes according to surgical technique.

Methods: We retrospectively reviewed outcomes in 202 consecutive PTs in 192 patients at our center. All patients received either r-ATG or alemtuzumab induction with tacrolimus/mycophenolate ± steroids.

Results: From 11/01 to 3/13, we performed 162 simultaneous kidney-PTs (SKPT), 35 sequential PTs after kidney, and 5 PTs alone (40 solitary PTs). A total of 179 (89%) were performed with portal-enteric and 23 with systemic-enteric drainage; all PTs were initially approached as intent-to-treat with portal-enteric drainage. Indications for systemic-enteric drainage were pancreas retransplantation following primary PT with portal-enteric drainage (N=9), central obesity (N=7), and unfavorable vascular anatomy (n=7). The systemic-enteric drainage group was characterized by more pancreas retransplants (39% versus 4%, p<0.0001), more solitary PTs (35% versus 18%, p=0.09), more African-Americans (39% versus 17%, p=0.02) and more patients with C-peptide positive diabetes (30% versus 13%, p=0.054) compared to the portal-enteric drainage group. Although the proportions of male recipients (70% versus 56%), recipients = 80 kg (30% versus 24%), and early relaparotomy rates (48% versus 36%) were all numerically higher in systemic-enteric versus portal-enteric PTs, respectively, none of these differences were significant. The incidence of early PT thrombosis was 4% in systemic-enteric compared to 8% in portal-enteric PTs (p=NS). With a mean follow-up of 5 years in systemic-enteric compared to 6 years in portal-enteric PT recipients, respective patient survival (70% versus 84%) and pancreas graft survival (61% versus 60%) rates were comparable; respective death-censored kidney graft survival (81% versus 82%) rates were similar.

Conclusion: In patients with disqualifying technical features for PT with portal-enteric drainage, comparable overall results can be achieved with systemic-enteric PT as a secondary technique.