Pancreas Transplantation With Enteroanastomosis Against Native Duodenum Versus Conventional Jejunal Anastomosis.

Abstract

Background: In recent years we have increased our pancreas-Tx (PTx) activity (7,6 pmp in 2013), in particular solitary PTx (50% in 2013). In Sep. 2012 we abandoned the duodenojejunostomi (DJ) in favor of drainage to native duodenum (DD), allowing easier endoscopic access for rejection surveillance and stenting of the pancreatic duct in cases of exocrine leakage. Material & Methods: 40 DD-PTx performed from 09-12 until 09-13 were compared to the last 40 DJ-PTx from the preceding era. In the DD-group scheduled biopsies of the duodenal segment (D) and pancreas (P) were planned at 3, 6, and 52 wks post-Tx. Results:Table: No Caption available.Somewhat unexpected, we experienced that the “retrovisceral” DD positioning gave rise to tension on the portal anastomosis resulting in an increased rate of vascular complications and thrombosis. We have adjusted several technical details, including extensive elongation of the portal vein. Both the duodenal segment and pancreas were easy to access endoscopically. There was a tendency towards more rejections in the DD group.Figure: No Caption available.Conclusions: After some technical adjustments, particularly regarding the portal anastomosis, the DD-technique seems safe and our results during the latter period are comparable to PTx-DJ. PTx-DD greatly facilitate endoscopic access to the graft. We believe the increased DD-rejections is due to improved surveillance. This approach may potentially improve solitary PTx results in future.