Duct-drained versus duct-occluded pancreatic grafts: a personal view

Conclusion My personal experience with DO and BD pancreas transplantation confirms that the DO technique is a safe procedure associated with more frequent, but less serious, complications. However, because of the likelihood of vascular thrombosis, graft survival probability does not reach the same level as that achieved by the BD technique.With triple drug induction therapy, recipients of BD pancreatic grafts often experience severe rejection episodes requiring intense antirejection therapy. Subsequently, the compromised immune system increases the susceptibility of the recipients to life-threatening infections. However, improved prophylactic and therapeutic measures, such as quadruple immunosuppressive induction therapy, CMV prophylaxis, and effective antifungal drugs, are now available. Therefore, these complications may now be prevented or effectively treated in most cases.The BD technique provides methods for diagnosing early graft rejection, which is obviously of major importance in isolated pancreas transplantation. Nevertheless, the further development of markers for early graft rejection, as well as of immunosuppressive approaches, seems necessary in order to improve the results of isolated pancreas transplantation. When the pancreas is transplanted simultaneously with a kidney using the BD technique, the probability of survival for both grafts is excellent. The problems directly associated with BD may be solved by draining the pancreatic duct to the intestine, which may ultimately prove to be the method that should be given preference.