Does Enteric Conversion Affect Graft Survival After Pancreas Transplantation with Bladder Drainage?

BACKGROUND Although bladder drainage is effective for monitoring urine amylase levels to detect graft rejection, enteric drainage is performed more frequently. The optimal method for monitoring pancreatic enzyme secretions remains unclear. We investigated graft survival in recipients of bladder drainage and assessed the risk of graft rejection and failure after enteric conversion. MATERIAL AND METHODS From January 1999 to October 2015, we performed 318 pancreas transplantations at our institution. We enrolled 180 recipients who underwent pancreas transplantation with bladder drainage (82 underwent enteric conversion and the rest did not). RESULTS The mean interval between pancreas transplantation and enteric conversion was 20±24 months. The graft survival rate was significantly higher in the enteric conversion group for 10 years after pancreas transplantation than in the maintain bladder drainage group. After enteric conversion, 14 recipients lost graft function. The interval between enteric conversion and graft failure was 43±26 months. In the enteric conversion group, immediate postoperative thromboembolectomy (HR=12.729, p=0.000), renal failure (HR=5.710, p=0.005), pancreas graft rejection after EC (HR=19.006, p=0.000), and delayed graft function (HR=7.021, p=0.001) had a significant relationship with graft failure. CONCLUSIONS Enteric conversion can be safe and effective for improving short- and long-term graft survival if performed after approximately 9 months. Caution should be exercised with enteric conversion if recipients have a history of thromboembolectomy, delayed graft function, or renal failure.