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

Area of Science:

• Transplantation Surgery
• Gastroenterology
• Nephrology

Background:

• Bladder drainage aids urine amylase monitoring for pancreas graft rejection, but enteric drainage is more common.
• Optimal monitoring of pancreatic enzyme secretions post-transplant remains undetermined.
• This study compares graft survival between bladder drainage and enteric conversion strategies.

Purpose of the Study:

• To investigate graft survival rates in pancreas transplant recipients initially managed with bladder drainage.
• To assess the risks of graft rejection and failure following conversion to enteric drainage.
• To determine the optimal timing and patient selection criteria for enteric conversion.

Main Methods:

• Retrospective analysis of 180 pancreas transplant recipients with bladder drainage from 1999-2015.
• Comparison of graft survival between recipients who underwent enteric conversion (n=82) and those who maintained bladder drainage.
• Analysis of factors associated with graft failure after enteric conversion.

Main Results:

• Graft survival was significantly higher at 10 years post-transplant in the enteric conversion group compared to the bladder drainage group.
• The mean interval to enteric conversion was 20 months; mean interval to graft failure post-conversion was 43 months.
• Factors significantly associated with graft failure post-enteric conversion included immediate postoperative thromboembolectomy, renal failure, pancreas graft rejection, and delayed graft function.

Conclusions:

• Enteric conversion is a safe and effective strategy for enhancing both short- and long-term pancreas graft survival, particularly when performed around 9 months post-transplant.
• Enteric conversion should be approached cautiously in patients with a history of thromboembolectomy, delayed graft function, or renal failure.
• Optimizing graft outcomes requires careful consideration of patient comorbidities and conversion timing.