World J Surg Surg Res | Volume 2, Issue 1 | Research Article | Open Access

Systemic Venous Versus Portal Venous Drainage in Simultaneous Pancreas-Kidney Transplantation: A Matched-Pair Analysis

David I Harriman, Venkat Gurram, Komal Gurung, Alan C Farney, Jeffrey Rogers, Giuseppe Orlando, Colleen Jay, Amber Reeves-Daniel and Robert J Stratta*

Department of General Surgery, Section of Transplantation, Wake Forest Baptist Health, USA

*Correspondance to: Robert J Stratta 

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The study purpose was to evaluate outcomes in vascularized Pancreas Transplantation (PTx) with
enteric exocrine drainage based on technique of venous delivery.
Methods: We retrospectively analyzed 231 Simultaneous Pancreas-Kidney Transplants (SPKTs)
performed at our center between 7/2003 to 7/2019 and identified 27 that were performed with
systemic venous (iliac vein) and enteric exocrine (Systemic-Enteric [S-E]) drainage. These 27
patients were compared to 27 case controls with portal venous (superior mesenteric vein) and
enteric exocrine (Portal-Enteric [P-E]) drainage matched for recipient age, gender, race, and date of
transplant. All patients received similar immunosuppressive regimens and underwent standardized
management protocols. Intention to treat was with P-E drainage.
Results: The 2 groups were well-matched for numerous donor, preservation, recipient, and
immunological characteristics. Indications for S-E drainage were central obesity/thickened
mesentery, unfavorable vascular anatomy, or surgeon preference. The S-E drainage group was
characterized by slightly more patients ≥ 80 kg (44% S-E vs. 26% P-E), with C-peptide positive
diabetes (30% S-E vs. 18% P-E), and with diabetes onset at >20 years of age (41% S-E vs. 26% P-E, all
p=NS), suggesting a Type 2 diabetes phenotype. Although the incidence of early pancreas thrombosis
(3.7% S-E vs. 0% P-E), early relaparotomy rates (30% S-E vs. 22% P-E), and mean initial length of
hospital stay (11 days S-E vs. 8 days P-E) were numerically higher in S-E vs. P-E SPKTs, none of
these differences were significant. With a mean follow-up of 5 years in both groups, respective one
and 3-year patient survival (100% and 96% S-E vs. 100% and 100% P-E), kidney graft survival (100%
and 96% S-E vs. 100% and 89% P-E), and pancreas graft survival (96% and 96% S-E vs. 100% and
100% P-E) rates were comparable.
Conclusion: The method of venous delivery of insulin following PTx does not appear to influence
medium-term outcomes in SPKT with enteric exocrine drainage.


Enteric drainage; Pancreas transplantation; Portal-enteric drainage; Simultaneous pancreas-kidney transplant; Systemic-enteric drainage; Venous drainage


Harriman DI, Gurram V, Gurung K, Farney AC, Rogers J, Orlando G, et al. Systemic Venous Versus Portal Venous Drainage in Simultaneous Pancreas- Kidney Transplantation: A Matched-Pair Analysis. World J Surg Surgical Res. 2019; 2: 1175..

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