Nasogastric decompression is not necessary after simultaneous pancreas-kidney transplantation

To determine whether eliminating routine nasogastric (NG) decompression after simultaneous pancreas-kidney (SPK) transplantation would reduce hospital length of stay without any increase in complications.

University of Wisconsin performs all pancreas transplantations with enteric drainage of exocrine secretions. Traditionally, NG tube decompression has been used for 5 postoperative days. This strategy was supported by the fact that most patients with diabetes have a history of gastroparesis. However, to date, no study has evaluated whether NG decompression is necessary post pancreas transplantation.

We have conducted a retrospective review of 182 primary SPK transplant recipients from 2002 to 2005. Before August 2004 we used NG decompression for 5 days postoperatively and resumed diet 24 hours after tube removal. After this period, diets were initiated with return of bowel function. We eliminated routine NG decompression in 2004. One hundred and thirty-two patients had NG decompression and 50 patients did not. Induction therapy changed during the study timeframe from basiliximab in the NG group to alemtuzumab in the no NG group. Maintenance therapy was similar between the 2 groups consisting of prednisone, mycophenolate mofetil, and tacrolimus.

Patients managed without NG tubes had significantly shorter length of stay (9.1 +/- 3.93 days) compared with patients managed with NG tube decompression (13.8 +/- 8.99 days) (P < 0.0001). Only 6 patients initially managed without NG tubes required NG placement during their hospital stay, including 2 patients returned to the operating room for nongastrointestinal complications. No differences existed between groups in complications, graft or patient survival.

Historically, NG tube decompression has been recommended postoperatively in SPK patients. These data refute this traditional clinical practice. SPK patients managed without NG decompression have shorter hospital length of stay, equivalent graft survival, and no increased morbidity.