Enteric conversion after pancreatic transplantation: resolution of symptoms and long-term results

• Published in: Clinical transplantation Vol. 25; no. 4; pp. 549 - 560
• Main Authors: Kleespies, Axel, Mikhailov, Michael, Khalil, Philipe N., Preissler, Gerhard, Rentsch, Markus, Arbogast, Helmut, Illner, Wolf-Dieter, Bruns, Christiane J., Jauch, Karl-Walter, Angele, Martin K.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.07.2011; Wiley
• Subjects: Adult; Anastomosis, Surgical; Biological and medical sciences; bladder drainage; Cohort Studies; cystoenteric conversion; Drainage; enteric drainage; exocrine secretion; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Survival; Humans; Kidney Function Tests; kidney transplantation (SPK); Kidney Transplantation - mortality; Male; Medical sciences; Middle Aged; Pancreas Transplantation - mortality; Postoperative Complications; Prospective Studies; Risk Factors; salvage operation; simultaneous pancreas; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the urinary system; Survival Rate; Time Factors; Tissue, organ and graft immunology; Treatment Outcome; Urinary Bladder - surgery; Prognosis; kidney transplantation (SPK); Concurrent; Operation; Homotransplantation; Kidney; Urinary bladder; Surgery; Graft; Pancreas; bladder drainage; cystoenteric conversion; enteric drainage; salvage operation; Conversion; Long term; Drainage; Medicine; Drug conversion; Symptomatology; Urinary system; Bypass; simultaneous pancreas; Exocrine secretion; Salvage treatment; Kidney transplantation
• ISSN: 0902-0063; 1399-0012
• DOI: 10.1111/j.1399-0012.2010.01363.x

Kleespies A, Mikhailov M, Khalil PN, Preissler G, Rentsch M, Arbogast H, Illner W‐D, Bruns CJ, Jauch K‐W, Angele MK. Enteric conversion after pancreatic transplantation: resolution of symptoms and long‐term results.
Clin Transplant 2011: 25: 549–560. © 2010 John Wiley & Sons A/S. :  Purpose:  Bladder drainage (BD) of pancreatic transplants is associated with a unique set of complications. We intended to analyze the incidence, indications, complications and long‐term results of enteric conversion procedures (EC). Methods:  Using a prospective database, 32 EC patients out of 433 simultaneous pancreas–kidney‐transplant (SPK) recipients were identified. Graft and patient survival rates were compared with those after primary enteric drainage (ED). Results:  The mean SPK‐EC interval was 5.0 yr, and the mean patient follow‐up was 13.8 yr. Indications for EC were genitourinary symptoms (62.5%), duodenal complications (15.6%), graft pancreatitis (12.5%), pyelonephritis (6.3%), and metabolic acidosis (3.1%). All patients reported significant long‐term resolution of symptoms. Surgical complications, reoperations, early graft loss, and 30‐d mortality occurred in 31.3%, 25.0%, 6.3%, and 3.1% of cases, respectively. Pancreatic graft and patient survival rates at 1, 5, and 10 yr after SPK were comparable between EC patients and ED patients at the same institution. Conclusion:  For the treatment of symptoms associated with BD, EC results in excellent long‐term graft function and significant resolution of symptoms even years after SPK. Postoperative morbidity after EC including early reoperation and graft loss, however, has to be considered.