Enteric conversion after bladder‐drained pancreas transplantation is not associated with worse allograft survival. Issue 9 (26th March 2019)

• Record Type: Journal Article
• Authors: Adler, Joel T.; Zaborek, Nick; Redfield, Robert R.; Kaufman, Dixon B.; Odorico, Jon S.; Sollinger, Hans W.
• Is Part Of: American journal of transplantation. Volume 19:Issue 9(2019)
• Page Start: 2543
• Page End: 2549
• Publication Date: 2019-03-26
• Subjects: clinical research/practice -- complication -- complication: medical/metabolic -- complication: surgical/technical -- graft survival -- health services and outcomes research -- pancreas/simultaneous pancreas‐kidney transplantation -- surgical technique; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.15341
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : In the early experience of pancreas transplantation, bladder drainage was favored, but it often caused urologic, metabolic, and infectious complications that necessitated conversion to enteric drainage. Long‐term graft survival after enteric conversion and the impact of time interval from transplantation to enteric conversion on graft survival is poorly understood. We studied all bladder‐drained first‐time pancreas transplantations performed at the University of Wisconsin from 1985 to 2000. Time to conversion was estimated with the Kaplan‐Meier technique, whereas risk factors associated with conversion were estimated via a time‐varying Cox proportional hazards model. Of 386 bladder‐drained pancreata, 162 (41.9%) eventually required enteric conversion, 29 (17.9%) within the first year. Median time to conversion varied by indication: 0.68 years for surgical, 3.1 years for urologic, and 2.7 years for metabolic disorders. In a time‐varying Cox model adjusting for donor and recipient factors, enteric conversion did not affect the risk of pancreas graft loss (hazard ratio [HR] 0.86, P = .26). Kidney survival was not associated with enteric conversion. When necessary due to symptoms or complications, enteric conversion of bladder‐drained pancreata is safe and does not affect overall graft survival. This relationship appears to be true no matter when the conversion is performed. Abstract : Of 386 bladder drained pancreata, of which 162 ultimately required conversion to enteric drainage, the authors find no association with the risk of pancreas or kidney graft loss, no matter when the conversion was performed.