A novel technique of portal-endocrine and gastric-exocrine drainage in pancreatic transplantation

Abstract

Background: Pancreas transplant (PT) is an established treatment for patients with diabetes mellitus. Diagnosis of rejection has continued to be problematic. In 2007, a new technique of PT with gastric exocrine (P-G) drainage was first performed at our institution. This technique facilitates access to pancreas allograft. The purpose of this study was to compare our experience with PT using P-G technique and the technique of portal enteric (P-E) with venting jejunostomy.

Study design: Thirty patients who underwent PT between 2007 and 2009 (G-I) and 30 consecutive patients before this time (G-II) were studied. In both groups arterial and venous anastomosis was similar to standard P-E technique. In G-I, the end of allograft jejunum was anastomosed to the anterior aspect of the stomach. In the G-II, allograft duodenum was anastomosed to the Roux-en-Y and end of Roux-en-Y was brought out as venting jejunostomy.

Results: Donor and recipient demographic data, number of antigen matches, and immunosuppressant were similar in both groups. All patients achieved euglycemia. In G-I, 3 patients underwent pancreatectomy, 2 owing to vessel thrombosis and 1 owing to chronic rejection. Two patients died with functioning pancreatic allografts. In G-II, 1 pancreas was removed owing to vessel thrombosis. Seven patients with cytomegalovirus and 4 patients with rejection in G-I were diagnosed with endoscopy of allograft duodenum. One-year patient and graft survivals were similar.

Conclusions: This technique has proven to be safe with good patient and allograft survival. Access to donor duodenum and pancreas allograft via endoscopy is unique to this technique and provides the added advantage of life-long easy access to allograft.