Portal-Endocrine and Gastric-Exocrine Drainage Technique in Pancreatic Transplantation

Abstract

Background: Pancreas transplant (PTx) is an established treatment for patients with diabetes mellitus. Diagnosisof rejection has continued to be problematic. In 2007, a new technique of PTx with portal-endocrineand gastric exocrine (P-G) drainage was first performed at our institution. This technique facilitates accessto pancreas allograft.Objective: To report our experience with the first 30 patients who underwent PTx using P-G technique.Methods: The first 30 patients who underwent PTx between 2007 and 2009 were studied. In these patients,arterial and venous anastomosis was similar to standard portal-enteric (P-E) technique, thoughcontrary to other techniques of enteric drainage, the end of allograft jejunum was anastomosed to theanterior aspect of the stomach.Results: Donor and recipient demographic data, number of antigen matches and immunosuppressant werecollected. All patients achieved euglycemia. 3 patients underwent pancreatectomy: 2 due to vessel thrombosisand 1 due to chronic rejection. 3 patients died—2 with functioning pancreatic and renal allografts.7 patients with CMV and 4 patients with rejection were diagnosed with endoscopy of allograft duodenumand treated. 1-year patient and graft survival was 94% and 85%, respectively.Conclusion: This novel technique of PTx has proven to be safe with good patient and allograft survival. Accessto donor duodenum and pancreas allograft via endoscopy is unique to this technique and providesthe added advantage of life-long easy access to allograft