TY - JOUR
T1 - Jejunal or Ileal Exocrine Drainage in Pancreas Transplantation
T2 - Impact on Gastrointestinal Function
AU - Doherty, Daniel T.
AU - Tan, Jaimee
AU - McFarlane, Robert
AU - Kingston, Jennifer
AU - Khambalia, Hussein A.
AU - Augustine, Titus
AU - Moinuddin, Zia
AU - van Dellen, David
N1 - Publisher Copyright:
© Başkent University 2023 Printed in Turkey. All Rights Reserved.
PY - 2023/7
Y1 - 2023/7
N2 - Objectives: Pancreas transplant can have serious complications requiring salvage pancreatectomy, and surgical approaches should be carefully considered, with jejunal or ileal anastomoses most often employed. The jejunum may reduce gastrointestinal disturbance, whereas the ileum is more immunogenic. Proximal gastrointestinal anastomoses pose challenges with salvage pancreatectomy and creation of high-output stoma, often in the context of end-stage renal failure. Here, we compared outcomes between these techniques. Materials and Methods: We retrospectively analyzed patient records of simultaneous pancreas and kidney transplants at a single center between 2013 and 2015, with follow-up to 2020. Results: Our center performed 86 simultaneous pancreas and kidney transplants during the study period; 10 patients were excluded because of incomplete records of anastomosis type. Of included recipients, 59.2% were men (mean age 41.5 ± 8.4 y), 72.4% were donors after brain death, and 98.7% had received a first pancreas transplant. Forty-three simultaneous pancreas and kidney transplants were performed with ileal anastomosis and 33 with jejunal anastomosis. We found no significant differences in recipient or donor factors or immunosuppression regimen between anastomosis groups and no significant differences in overall patient, pancreas, or kidney graft survival or in gastrointestinal complications. Hospital length of stay was higher with ileal anastomosis (median 14 vs 19 days; P <.05), as was cold ischemic time (median 8:48 vs 9:31 hours; P <.05). Three patients required salvage pancreatectomy and loop ileostomy formation with multiorgan support, prolonged intensive care unit stay, relaparotomy, and/or laparostomy. Conclusions: Long-term outcomes were comparable between our patient groups. Catastrophic complications occur in a minority of cases, requiring salvage surgery. More complications occurred with ileal anastomosis, but this approach allows graft pancreatectomy and formation of loop ileostomy, avoiding a more proximal stoma in clinically unstable patients. Further studies are needed to examine the impact of enteric anastomosis site.
AB - Objectives: Pancreas transplant can have serious complications requiring salvage pancreatectomy, and surgical approaches should be carefully considered, with jejunal or ileal anastomoses most often employed. The jejunum may reduce gastrointestinal disturbance, whereas the ileum is more immunogenic. Proximal gastrointestinal anastomoses pose challenges with salvage pancreatectomy and creation of high-output stoma, often in the context of end-stage renal failure. Here, we compared outcomes between these techniques. Materials and Methods: We retrospectively analyzed patient records of simultaneous pancreas and kidney transplants at a single center between 2013 and 2015, with follow-up to 2020. Results: Our center performed 86 simultaneous pancreas and kidney transplants during the study period; 10 patients were excluded because of incomplete records of anastomosis type. Of included recipients, 59.2% were men (mean age 41.5 ± 8.4 y), 72.4% were donors after brain death, and 98.7% had received a first pancreas transplant. Forty-three simultaneous pancreas and kidney transplants were performed with ileal anastomosis and 33 with jejunal anastomosis. We found no significant differences in recipient or donor factors or immunosuppression regimen between anastomosis groups and no significant differences in overall patient, pancreas, or kidney graft survival or in gastrointestinal complications. Hospital length of stay was higher with ileal anastomosis (median 14 vs 19 days; P <.05), as was cold ischemic time (median 8:48 vs 9:31 hours; P <.05). Three patients required salvage pancreatectomy and loop ileostomy formation with multiorgan support, prolonged intensive care unit stay, relaparotomy, and/or laparostomy. Conclusions: Long-term outcomes were comparable between our patient groups. Catastrophic complications occur in a minority of cases, requiring salvage surgery. More complications occurred with ileal anastomosis, but this approach allows graft pancreatectomy and formation of loop ileostomy, avoiding a more proximal stoma in clinically unstable patients. Further studies are needed to examine the impact of enteric anastomosis site.
KW - Anastomoses
KW - Pancreas transplant
KW - Pancreatectomy
UR - http://www.scopus.com/inward/record.url?scp=85167982594&partnerID=8YFLogxK
U2 - 10.6002/ect.2022.0342
DO - 10.6002/ect.2022.0342
M3 - Article
C2 - 37584539
AN - SCOPUS:85167982594
SN - 1304-0855
VL - 21
SP - 586
EP - 591
JO - Experimental and clinical transplantation
JF - Experimental and clinical transplantation
IS - 7
ER -