Simultaneous pancreas-kidney transplantation with enteric drainage of exocrine secretions

OBJECTIVES: To simplify the enteric drainage (ED) procedure and to decrease surgical and metabolic complications in simultaneous pancreas-kidney transplantation (SPK) patients. METHODS: Between June 2000 and June 2002, nine patients with insulin-dependent diabetes mellitus (IDDM) and uremia underwent simultaneous pancreas-kidney transplantation. The arterial inflow of the pancreas was based upon the right external iliac artery, while venous drainage was systemic via the external iliac vein. The allografts' exocrine secretions were drained into the proximal jejunum via a two-layer hand sewn, side-to-side donor duodenum to proximal small bowel anastomosis after reperfusion. No Roux-en-Y an astomosis of the jejunum was performed. The kidney graft was placed in the left iliac fossa. Quadruple immunosuppressive therapy with antilymphocyte globulin or anti-CD25 monoclonal antibody (Zenapax), tacrolimus, mycophenolate mofetil and steroids was standard treatment in all patients. RESULTS: This procedure was successfully applied in all 9 patients without complication referable to the technique. All patients had achieved euglycemia and excellent renal function, and stopped being dependent on an external insulin source. Fasting serum glucose fell from 9.5 preoperatively to 4.8 mmol/L and remained stable thereafter. At the time this paper was written, the grafts from eight patients were functioning well. CONCLUSIONS: Our primary experience suggests that SPK with ED without Roux-en-Y anastomosis represents a more physiologic milieu, and a viable alternation to replace the bladder (BD) as the primary route of drainage for exocrine secretions of the pancreas. It is a feasible and safer procedure.