Pancreaticoduodenal transplantation with portal venous and enteric drainage in rats.

Abstract

The use of combined pancreatic and renal transplantation in patients with diabetes and end-stage renal failure has gained widespread recognition as an acceptable treatment option. The prevailing method used for transplantation of the pancreas involves anastomosis of the graft’s portal vein and the recipient’s iliac vein to provide systemic venous drainage of the graft, and a duoden-ocystostomy to provide bladder drainage of exocrine secretions[1]. Altho ugh graft survival rates have improved with the use of this technique, potential postoperative problems arise due to the physiologically abnormal exocrine and venous drainage of the pancreas allograft. Bladder drainage of exocrine secretions increased the loss of bicarbonate in the urine, creates electrolyte derangements, and contributes to dehydration leading to a state of metabolic acidosis[2-4]. Pancreatic secretions drained into the bladder also provide a constant source of irritation to the bladder mucosa, accentuating the abnormalities associated with autonomic diabetic dysfunction. This environment subsequently led to recurrent hematuria, infection, and repeated episodes of graft pancreatitis[5-7]. The method of pancreas transplantion with portal venous and enteric drainage can overcome these problems. One of the eariest series of portal pancreatic transplants was reported in 1984[8]. Because of the complex surgical technique, big animal models were used widely in the pancreas transplantation research[9-11], up to now, there has been only portal venous drainage in segmental pancreatic transplantation in rats[12]. In our study, we established an animal model of pancreaticoduodenal transplantation with portal venous drainage through the superior mesenteric vein and enteric drainage in rats in order to achieve a better understanding of the immunology and physiology of this graft.