A comparison of portal venous versus systemic venous drainage in pancreas transplantation |
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Authors: | Eric Siskind Leo Amodu Chang Liu Meredith Akerman Joshua Stodghill Ravinder Wali James Piper Johann Jonsson Ernesto Molmenti Jorge Ortiz |
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Affiliation: | 1. Inova Fairfax Medical Campus, Department of Surgery, Inova Kidney and Pancreas Transplant Program, 3300 Gallows Road, Falls Church, VA, 22042, USA;2. Northwell Health System, Transplant Center, 300 Community Drive, Manhasset, NY, 11030, USA;3. University of Toledo Medical Center Kidney Transplant Program, 3000 Arlington Avenue, Toledo, OH, 43614, USA |
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Abstract: | BackgroundThe decision to utilize portal or systemic venous drainage in pancreas transplantation is surgeon- and center-dependent. Information regarding the superior method is based on single-center reports and animal models.MethodsUNOS data on adults receiving pancreas and kidney-pancreas transplants from 1987 to 2016 were analyzed (n = 29 078). The groups analyzed were: systemic venous pancreas graft drainage (SVD, n = 24 512) or portal venous pancreas graft drainage (PVD, n = 4566). A Cox proportional hazard model compared patient and allograft survival between groups.ResultsNo statistically significant differences were observed for patient and allograft survival at 1, 3, 5, 10, or 15 years post-transplant at each time interval and cumulatively (patient – HR:1.041; 95% CI:0.989–1.095; allograft – HR:0.951; 95% CI:0.881–1.027). PVD reduced the risk of death by 22.0% (P = 0.017) compared to SVD for patients undergoing pancreas after kidney transplant (PAK); no statistically significant difference was found for patients undergoing other types of transplants.ConclusionThere is no significant clinical difference in patient or allograft survival between PVD and SVD in pancreas transplantation for the majority of patients. For the subgroup of PAK, PVD was associated with decreased mortality. For individual surgeons, center and patient scenarios should dictate which technique is performed. |
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Keywords: | Correspondence: Eric Siskind Inova Fairfax Medical Campus 3300 Gallows Road Falls Church VA 22042 USA. |
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