Elective enteric conversion following bladder drained pancreas transplantation; A safe and effective operation

ABSTRACT NUMBER: NESTAC_08

 

AUTHORS
Michaela Paul1, Emily R Thompson1, IK Ibrahim1, Derek M Manas2, Steve A White2, Colin H Wilson1, 2

AFFILIATIONS
1 NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, Newcastle University, Newcastle upon Tyne, NE2 4HH
2 Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, NE7 7DN

CORRESPONDING AUTHOR CONTACT EMAIL
ku.ca.eltsacwen@3nospmoht.ylime98

MAIN ABSTRACT TEXT

Background
Enteric drainage (ED) is the most common method for drainage of exocrine secretions in pancreas transplantation. However, there may still be cohort of patients who would benefit from bladder drainage (BD). Primary ED can be complicated by anastomotic leaks causing sepsis, reoperation and even graft loss. Recipients at high risk of developing anastomotic breakdown or rejection (e.g. previous kidney transplant, abdominal surgery, marginal duodenal vascularity) may benefit from a planned two-step approach with initial BD followed by EC. The purpose of this study was to review our centre’s experience of EC.

Methods
We conducted a retrospective review of all pancreas transplants performed in our centre from 2000 until October 2017. Of this cohort 33 recipients were primarily bladder drained (BD) and 10 subsequently went on to elective EC. A minimum of 12 months follow-up information was available.

Results
The median time from transplant to conversion was 18 months. The main indications for conversion were urological complications. The majority of recipients had complete resolution of urological complications. All patients on oral bicarb pre-conversion no longer required this therapy post-conversion. Pancreas graft function was well maintained with a mean 1year HbA1c 34.1mmol/ml (±5.7). Kidney graft function was also preserved with a mean 1year creatinine of 106µmol (±22.9). There were no significant surgical complications. The median length of stay was 9.5 days

Conclusion
Our series has demonstrated that elective enteric conversion is a safe, effective operation following pancreas transplantation, resulting in the resolution of urological complications with no impact on graft function.