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Presenter: M., Perosa, São Paulo, Brazil
Authors: M. Perosa, H. Noujaim, L.T. Mota, J.R. Branez, L.E. Ianhez, R.A. Oliveira, P.H.F. Amaral, J.E. Vetorazzo Filho, T. Genzini
Portal-enteric drainage by retrocolic approach versus systemic-bladder drainage in solitary pancreas transplants. Clinical and immunological outcome of 87 patients
M. Perosa, H. Noujaim, L.T. Mota, J.R. Branez, L.E. Ianhez, R.A. Oliveira, P.H.F. Amaral, J.E. Vetorazzo Filho, T. Genzini
HEPATO, Organ Transplantation, São Paulo, Brazil
Solitary pancreas transplants (PT) are tradionally more immunogenic and therefore represent a good clinical model for comparative evaluation of immunological outcomes among different surgical techniques.
Objective: We retrospectively analyzed clinical and immunological outcomes in patients submitted to PT with portal-enteric (PE) by retrocolic approach versus systemic-bladder (SB) drainage.
Methods: Eighty-seven patients were studied after solitary PT, including 50 (37 PAK and 13 PTA) with SB drainage from jan/2006 to oct/2008 and 37 (30 PAK and 7 PTA) with PE drainage from oct/2008 to feb/2011. All patients were immunosuppressed with thymoglobulin, tacrolimus, mycophenolate sodic and steroids.
Results: Donor and recipient demographic, donor cause of death, PTA/PAK distribution and occurrence of retransplants were similar between the two groups. Cold ischemia time was shorter in EP group ( 13.5h X 15.3h for SB, p=0.0004). 1-Year patient and pancreas graft survival were similar between EP and SB groups, 100% x 97.9% and 81.1% x 84% respectively. Acute rejection incidence was higher in SB group (28.5% x 16.2%), albeit not significant (p=0.07). Chronic rejection was significantly higher after SB transplants ( 22% x 5.4%, p=0.013).
Conclusions: The PE method of PT can achieve excellent patient and graft outcomes and seems to have lower rates of acute and chronic rejection, although a shorter cold ischemia time and follow-up were verified in this group.
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