Figure 1511

Early attempts using enteric drainage (ED) techniques resulted in prohibitively high rates of intra-abdominal abscesses, wound infections, and mycotic aneurysms threatening both graft and patient. Thereafter, bladder drainage (BD) via a duodenocystostomy evolved in the United States as the safest and most frequently performed exocrine drainage procedure. It has been suggested that BD affords the ability to monitor urinary amylase levels as an indicator of rejection, which may be useful in the setting of a solitary pancreas transplant. However, in recipients of simultaneous pancreas-kidney (SPK) transplant in whom kidney function serves as a marker of rejection monitoring of urinary amylase levels is not necessary to achieve excellent long-term graft survival.

As experience grew with BD, however, it was found that up to 25% of patients with BD developed a significant urologic or metabolic complication requiring surgical conversion of exocrine secretions to ED [4,5]. Renewed interest in primary ED has resulted. Several recent retrospective studies have compared BD pancreas transplants to ED transplants. These studies have demonstrated equivalent short-term graft survival rates without increased risks of infectious complications and pancreatic enzyme leaks [1-3]. ED is associated with fewer urinary tract infections (UTIs) and no hematuria. Patients who have ED experience less dehydration and metabolic acidosis and, as a result, a reduced need for fluid resuscitation and bicarbonate supplementation [3]. Finally, in patients who have ED the Foley catheter can be removed within several days, whereas patients who have BD require prolonged drainage (up to 14 days) to permit healing of the duodenocystostomy. Consequently, with ED, patients are able to leave the hospital sooner. ED has proved to be more physiologic and results in less morbidity compared with BD. Therefore, ED is rapidly gaining popularity as the method of choice for handling graft exocrine secretions in pancreas transplantation.

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