TY - JOUR
T1 - Pancreas-kidney transplantations with primary bladder drainage followed by enteric conversion
T2 - Graft survival and outcomes
AU - Marang-Van De Mheen, Perla J.
AU - Nijhof, Hugo W.
AU - Khairoun, Meriem
AU - Haasnoot, Ada
AU - Van Der Boog, Paul J.M.
AU - Baranski, Andrzej G.
PY - 2008
Y1 - 2008
N2 - Background. In the Leiden University Medical Centre, a two-step approach is routinely used in simultaneous pancreaskidney (SPK) transplantations: primary bladder drainage (BD) followed by elective enteric conversion. The rationale for this approach is to prevent the short-term disadvantages of primary enteric drainage (intra-abdominal abscesses, pancreas graft loss) and the long-term urological complications related to bladder drainage. Aim of the present study is to evaluate survival and (urological) complications of this approach compared to enteric drainage (ED). Methods. Patient records of all 98 SPK transplantations in the period 1997-2004 were reviewed for complications during the initial hospitalization until 30 days after discharge, and to assess urological complications and graft survival until the last hospital visit. Median duration of follow-up was 4.3 years for pancreas graft survival, 4.7 years for kidney graft survival, and 4.8 years for patient survival. Results. Patient survival was significantly better in BD patients than in ED patients (χ2=9.89 P<0.01). Pancreas graft survival was also better in BD patients after adjustment for the longer pancreas warm ischemia time in BD patients (P=0.05). The survival rates in our patient population seem higher than reported by the International Pancreas Transplant Registry, particularly in BD patients. Urological complications occurred in nine BD patients (10.3%), comparable to the rates reported for enteric-drained grafts. Conclusions. This two-step approach of SPK transplantation results in excellent survival rates, with urological complication rates comparable to those reported for enteric-drained grafts, and may thus be viewed as a safe and effective procedure of SPK transplantation.
AB - Background. In the Leiden University Medical Centre, a two-step approach is routinely used in simultaneous pancreaskidney (SPK) transplantations: primary bladder drainage (BD) followed by elective enteric conversion. The rationale for this approach is to prevent the short-term disadvantages of primary enteric drainage (intra-abdominal abscesses, pancreas graft loss) and the long-term urological complications related to bladder drainage. Aim of the present study is to evaluate survival and (urological) complications of this approach compared to enteric drainage (ED). Methods. Patient records of all 98 SPK transplantations in the period 1997-2004 were reviewed for complications during the initial hospitalization until 30 days after discharge, and to assess urological complications and graft survival until the last hospital visit. Median duration of follow-up was 4.3 years for pancreas graft survival, 4.7 years for kidney graft survival, and 4.8 years for patient survival. Results. Patient survival was significantly better in BD patients than in ED patients (χ2=9.89 P<0.01). Pancreas graft survival was also better in BD patients after adjustment for the longer pancreas warm ischemia time in BD patients (P=0.05). The survival rates in our patient population seem higher than reported by the International Pancreas Transplant Registry, particularly in BD patients. Urological complications occurred in nine BD patients (10.3%), comparable to the rates reported for enteric-drained grafts. Conclusions. This two-step approach of SPK transplantation results in excellent survival rates, with urological complication rates comparable to those reported for enteric-drained grafts, and may thus be viewed as a safe and effective procedure of SPK transplantation.
KW - Bladder and enteric drainage
KW - Graft outcomes
KW - Graft survival
KW - Pancreas-kidney transplantation
KW - Urological complication
UR - http://www.scopus.com/inward/record.url?scp=44449140597&partnerID=8YFLogxK
U2 - 10.1097/TP.0b013e31816361f7
DO - 10.1097/TP.0b013e31816361f7
M3 - Article
C2 - 18347529
AN - SCOPUS:44449140597
SN - 0041-1337
VL - 85
SP - 517
EP - 523
JO - Transplantation
JF - Transplantation
IS - 4
ER -