Retroperitoneal pancreas transplantation with a Roux-en-Y duodenojejunostomy for exocrine drainage

doi:10.21203/rs.3.rs-4667471/v1

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Research Article

Retroperitoneal pancreas transplantation with a Roux-en-Y duodenojejunostomy for exocrine drainage

https://doi.org/10.21203/rs.3.rs-4667471/v1

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Background

Pancreatic transplantation is the only definitive surgical treatment for diabetes mellitus. Currently, most transplant centers use enteric exocrine drainage of pancreatic secretions; however, experts disagree on which part of the gastrointestinal tract is preferable for enteric anastomosis. We analyzed the outcomes of retroperitoneal pancreatic transplantation with enteric drainage of pancreatic secretions.

Materials and Methods

We evaluated the outcomes of 60 simultaneous retroperitoneal pancreas-kidney transplantations. Based on the type of enteric anastomosis, the patients were divided into two groups: the study group consisted of 10 patients who underwent enteric drainage via Roux-en-Y duodenojejunostomy, and the control group included 50 patients who underwent exocrine drainage via duodenoduodenal anastomosis. No statistically significant differences were observed between the groups in terms of the main parameters.

Results

The rate of surgical complications did not differ significantly between the groups (p > 0.05). Clavien IVb complications occurred only in the control group (n = 4.8%). The in-hospital pancreatic graft survival rate in both groups was 80%, whereas the recipient survival rates were 90% and 84%, in the study and control groups, respectively (p < 0.05).

Conclusion

Retroperitoneal pancreatic transplantation with exocrine drainage via a Roux-en-Y duodenojejunostomy is an effective alternative technique that reduces the rate of severe surgical complications.

Pancreas transplantation

simultaneous pancreas-kidney transplantation

duodenojejunal anastomosis

duodenoduodenal anastomosis

surgical complications

pancreatic graft survival

recipient survival

Diabetes mellitus (DM) has been recognized by the World Health Organization as an epidemic of non-infectious etiology and is a real challenge for the medical community worldwide. According to the International Diabetes Federation Report, there are over 463 million people with DM worldwide in 2021.¹ According to the Data Registry, 4.8 million patients with DM were registered in Russia in 2021, and 265,400 of them had type 1 DM.^{2, 3} Diabetic nephropathy (DN) is the most threatening complication of type 1 DM, exacerbating its course in 25.9% of patients.⁴ These patients demonstrated the lowest survival rates when renal replacement therapy is used. In the opinion of the professional medical community, simultaneous pancreas and kidney transplantation (SPKT) is the best treatment option for this group of patients.^{5, 6} The initial ideological goal of pancreas transplantation (PTx) is kidney graft nephroprotection, which contributes to a fold increase in graft survival.^{7, 8} In addition to a significant improvement in quality of life, SPKT increases the long-term survival of patients with stage 4–5 chronic kidney disease originating from DN.

Conceptually, PTx allows lost endocrine function of the pancreas to be replaced; however, the exocrine parenchyma of the pancreas graft (PG) is the main cause of most non-vascular complications. Historically, the issue with the most significant impact on PTx outcomes was PG exocrine drainage. Various surgical techniques have been used, including ligation⁹ and duct injection with synthetic polymers,^{10, 11} performing cutaneous graft duodenostomy,¹² open-duct drainage¹³ and urinary drainage.^14–16 Currently, 95% of all PTxs are performed with enteric drainage, which has been proven to be the most physiological method.^{17, 18} Some authors report the use the small intestine to form an interintestinal anastomosis, placing the graft in the peritoneal cavity. This is often associated with prolonged intestinal paresis and septic complications.¹⁶ Others report retroperitoneal PG placement and drainage of pancreatic secretions into the recipient’s duodenum^{19, 20} with the peritoneal cavity remaining intact. With this approach, in case of complications, the pathology focus is located outside the peritoneal cavity and is often amenable to minimally invasive treatment. When using this technique, the incidence of interintestinal anastomosis failure is 5–20%,²¹ and the mortality in such cases is 78%.²²

We implemented an PTx technique that uses the advantages of retroperitoneal graft placement and obviates the main disadvantage of duodenal drainage.

Recipients

The study was included 60 patients who underwent retroperitoneal SPKT between 2011 and 2022 and was single-center, prospective study with historical control group. Patients inclusion criterion was type 1 diabetes mellitus with unsatisfactory glycemic control, complicated by stage 5 chronic kidney disease resulting in diabetic nephropathy. The exclusion criteria were terminal conditions, uncorrectable dysfunctions of vital organs, untreatable systemic and local infections (AIDS, replication of hepatitis viruses, active tuberculosis, etc.), septic conditions, malignant neoplasms, developmental defects accompanying diabetes mellitus that cannot be corrected, narcotic and/or alcohol addiction, psychosocial factors. The study group comprised 10 patients who underwent PTx with modified Roux-en-Y duodenojejunostomy. The control group included 50 patients who underwent PTx with exocrine drainage via a duodenoduodenal anastomosis. The study was approved by the Institutional Review Board at the N.V. Sklifosovsky Research Institute for Emergency Medicine (№1-22 from 11.01.2022)

Surgical technique

In the study group, the small intestine was divided at a distance of 40–60 cm from the ligament of Treitz using a linear stapler. Next, a side-to-side anti-peristaltic interintestinal anastomosis was performed between the two ends of the native jejunum using the linear staple technique (Figure 1a).

Roux-en-Y, excluding the small intestinal loop, was drawn through the parietal peritoneal foramen under the recipient’s ascending colon into the retroperitoneal space to the duodenal stump of the pancreaticoduodenal graft. A side-to-side duodenojejunal anastomosis was formed in the retroperitoneal space between the stump of the donor duodenum and the Roux-en-Y-excluded loop of the recipient jejunum (Figure 1b).

In the parietal peritoneal foramen, the peritoneum was fixed with interrupted sutures to the excluded loop of the jejunum, isolating the pancreatic graft from the peritoneal cavity (Figure 2).

In the control group, the duodenum was isolated, and a side-to-side hand-sewn duodenoduodenal anastomosis was performed using a two-layer uninterrupted intestinal suture (Figures 3 and 4).

The kidney graft cold ischemia time varied from 5–12.5 h and from 5–14 h in the study and control groups, respectively, the respective medians [0.25;0.75 percentile] being 7.3 [7; 7.8] h and 7.75 [6.6;9.5] h. The pancreatic graft cold ischemia time varied from 7–10 h and from 6.5–13 h in the study and control groups, respectively, with median values of 9 [8.6;9.4] h and 9 [8.1;11] h, respectively.

Immunosuppressive therapy

Induction immunosuppressive therapy included methylprednisolone 750 mg intraoperatively, then 250 mg on postoperative day 1 and 2, basiliximab 20 mg intraoperatively, and on postoperative day 4. Triple maintenance immunosuppressive therapy included tacrolimus, mycophenolic acid, and methylprednisolone.

Prophylactic antibiotic therapy

Perioperative antibiotic prophylaxis was administered using 1000 mg meropenem twice daily for 7 days, 500 mg 3 times a day for 10 days, and 500 mg vancomycin once daily for 5 days.

Antisecretory therapy

For antisecretory therapy, octreotide was administered via an infusion pump at a dose of 1200 µg/24 h for 5 days. On postoperative day 5, the antisecretory therapy was converted from intravenous to subcutaneous octreotide administration at a dose of 300 μg 3 times a day with the dose tapering down with complete withdrawal after blood amylase level returned to normal.

Assessment of surgical complications

Surgical complications were graded according to the Clavien-Dindo Classification modified by Grochowiecki²³.

Statistical analyses

Statistical analyses were performed using IBM SPSS Statistics version 24 software (IBM Corp, Armonk, NJ, USA). Quantitative parameters were assessed for compliance with normal distribution using the Shapiro–Wilk test. Comparison of two groups in terms of a quantitative parameter having a normal distribution, provided that the variances were equal, was performed using Student's t-test. Comparison of the two groups in terms of a quantitative parameter, the distribution of which differed from the normal distribution, was performed using the Mann–Whitney U test. Percentage comparisons in the four-field contingency tables were performed using Fisher's exact test (with expected phenomenon values lower than 10). To assess the statistical significance of the differences between two or more relative parameters, Pearson's chi-square test was used. The Kaplan–Meier method was used to calculate patient and graft survival rates. Differences were considered statistically significant at p<0.05.

The detailed characteristics of the patients in the study and control groups are presented in Table 1.

Table 1. Demographic data of recipients in the study and control groups

Parameter	Study group (n=10)	Control group (n=50)	p
Men/women, n/n	2/8	19/31	0.47¹
Age, years*	36 [32;39]	35 [33;36]	0.55²
BMI, kg/m²*	21 [19;22]	21 [20;23]	0.41³
RRT duration, years*	3 [1;4]	2 [1;4]	0.67³
History of diabetes, years*	26 [23;28]	24 [20;29]	0.74³

*Median [0.25;0.75 percentile]; ¹Fisher's exact test; ²Student's t test; ³Mann–Whitney U test; BMI, body mass index; RRT, renal replacement therapy

Organs donated after ascertaining brain death from deceased standard criteria donors were used for transplantation (Table 2).

Table 2. Donor characteristics in the study and control groups

Parameter	Study group (n=10)	Control group (n=50)	R
Men/women, n/n	7/3	44/6	0.16¹
Age, years*	29 [25;32]	28 [26;29]	0.64²
TBI/CVA, n/n	6/4	32/18	1.0¹
PG cold ischemia time, h*	9 [8.625;9.375]	9 [8,125;11]	0.41³
Donor total blood amylase, U/L*	61 [54;109]	73 [57;117]	0.66³
Bacteriology study of perfusate: positive/negative result, n/n	1/9	3/47	0.53¹

* Median [0.25;0.75 percentile]; ¹Fisher's exact test; ²Student’s t-test; ³Mann-Whitney U test; TBI, traumatic brain injury; CVA, cerebrovascular accident; PG, pancreas graft

There was a high degree of HLA antigen incompatibility in the donor-recipient pairs in the study and control groups: six [6;6] and five [4;6] antigen mismatches, respectively.

The postoperative course was uneventful in 24 patients; 36 patients developed 44 complications. The incidences of early surgical complications were 30% and 66% in the study and control groups, respectively (p=0.08). A comparative description of surgical complications in the groups is presented in Table 3.

Table 3. Comparison of surgical complications in the study and control groups

Complication	Study group (n=10)	Control group (n=50)	p*
Severity grade IIIa
Peripancreatic abscess, n (%)	1 (16.7 %)	2 (5.3 %)	>0.05
Peripancreatic infection, n (%)	1 (16.7 %)	6 (15.8 %)
PPFC, n (%)	1 (16.7 %)	13 (34.2 %)
Intestinal bleeding, n (%)	0	2 (5.3 %)
Severity grade IIIb
Intestinal bleeding, n (%)	1 (16.7 %)	1 (2.6%)	>0.05
Peripancreatic abscess, n (%)	0	1 (2.6%)
Peripancreatic infection, n (%)	0	1 (2.6%)
Bleeding (venous/arterial), n (%)	0	1 (2.6%)
Severity grade IVa
Occlusive arterial thrombosis, n (%)	1 (16.7 %)	2 (5.3 %)	>0.05
Occlusive venous thrombosis, n (%)	1 (16.7 %)	2 (5.3 %)
Interintestinal anastomosis failure, n (%)	0	2 (5.3 %)
Clinically significant stenosis of the splenic artery, n (%)	0	1 (2.6%)
Severity grade IVb
Interintestinal anastomosis failure + peripancreatic infection, n (%)	0	4 (10.5 %)	>0.05
Total complications	6	38

*Fisher's exact test; PPFC, peripancreatic fluid collection

The total number of complications per patient was 0.6 and 0.8 in the study and control groups, respectively. A comparative analysis showed no statistically significant effect of the type of pancreatic exocrine secretion drainage on the incidence of surgical complications (p>0.05).

The length of hospital stay was significantly shorter in the study group (21 [14;30] days) than in the control group (41 [29;63] days) (p=0.03). The overall in-hospital pancreatic graft survival rate was 81.7%. The death-censored pancreaticoduodenal graft survival rate was 83.3%. The in-hospital pancreatic graft survival rate was 80% in each group. Death-censored in-hospital pancreatic graft survival was 90% and 80% in the study and control groups, respectively. One-year pancreas graft survival rate was 76% in the control group and 90% in the study group. The overall in-hospital survival rate was 85%. The in-hospital recipient survival rates showed no statistically significant differences between the groups, with 90% in the study group and 84% in the control group (p>0.05). One-year survival of patients were 82% and 90% in the control and study groups, respectively.

Surgical treatment of diabetes mellitus currently includes simultaneous kidney and pancreas transplantation, pancreas after kidney and pancreas transplant alone. With improvements in surgical technique, postoperative management and immunosuppressive therapy, pancreas graft survival has improved and now matches graft survival rates of kidney and liver transplant. Thus, the current survival rates for patients and transplants exceed 90% after 1 year.²³

The first pancreas transplant was performed in 1966. Then William D. Kelly and Richard C. Lillehei performed a pancreas transplantation with main pancreatic duct ligation.²⁴ Subsequently, surgeons used various methods of drainage of pancreatic secretions: drainage into the abdominal cavity, filling of the duct of Wirsung, drainage into the bladder and own ureter. Currently about two thousand pancreas transplantations are performed annually worldwide, and enteric drainage of pancreatic secretions is currently performed in 95% of transplant centers.²⁵ Some centers perform intraperitoneal transplantation by forming a duodenojejunal anastomosis, whereas others prefer the retroperitoneal pancreatic transplantation technique with formation of a duodenoduodenal anastomosis. Some authors describe successful attempts at gastric drainage.²⁶ However, the number of surgical complications still remains high and reaches 55%.^27,28Despite the fact that sufficient international experience has accumulated in pancreas transplantation, there is currently no standardized drainage option.^29,30 On the one hand, an undoubted advantage is the retroperitoneal location of the PG, in which the abdominal cavity remains relatively intact and there is the possibility of minimally invasive treatment methods. However, if PG is placed retroperitoneally duodenal drainage is used which increases the risk of severe surgical complications. High recipient mortality rates have been reported in cases of duodenoduodenal anastomosis incompetence and the development of infectious complications requiring graft removal. When using this technique, the incidence of interintestinal anastomosis failure is 5–20%,²¹ and the mortality in such cases is 78%.²²On the other hand, small intestinal drainage is a technically simpler and safer method for forming an anastomosis, but the intra-abdominal location carries the risk of severe complications due to the lack of delimitation of the graft from the abdominal cavity.

In the present study, we describe the results of a transplant series using a technique that combines the advantages of retroperitoneal graft placement and enteric drainage and obviates the main disadvantage of duodenal drainage. The overall incidence of early surgical complications and graft and recipient survival rates did not differ significantly with regard to the method of graft pancreatic secretion drainage. Severe Clavien–Dindo grade IVb surgical complications occurred only in the control group. It is important that the occurrence of interintestinal anastomosis failure and peripancreatic infection (four cases) led to death in 100% of cases in patients with duodenoduodenal anastomosis formation. This fact indicates more severe management of patients with surgical complications after transplantation with duodenal drainage. Also length of hospitalization of patients in study group was significantly shorter. This is due to fewer severe surgical complications in these patients. The results obtained in this study suggest that this surgical technique is an effective alternative for pancreatic transplantation.

Limitations in this study are those inherent to any retrospective and prospective analysis of a database with various biases. The sample size for the groups is small due to the surgery's rarity, which can limit the statistical power to detect effects. The selection criteria for SPKT may vary from center to center, inducing a selection bias. Experience with retroperitoneal pancreas transplantation is still not matured in many centers, which may have impacted the adverse outcomes. Recently, future research will be needed to examine that question.

Retroperitoneal pancreatic transplantation with enteric drainage of pancreatic secretions by forming a duodenojejunal anastomosis on the Roux-en-Y-excluded small intestine loop is an effective alternative transplantation technique that reduces the number of severe surgical complications.

Conflicts of interest: The authors have no conflicts of interest to declare.

Funding: This study was sponsored by the Moscow Center for Innovative Technologies in Healthcare.

Ethics approval and consent to participate:

The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. The trial was conducted in accordance with the Declaration of Helsinki (as revised in 2013). The study was approved by the Institutional Review Board at the N.V. Sklifosovsky Research Institute for Emergency Medicine (№1-22 from 11.01.2022) and informed consent was taken from all individual participants.

Consent for publication: we confirm our responsibility for ensuring the data's integrity and accuracy of the data analysis, as well as the decision to submit the manuscript for publication.

Availability of data and materials: we affirm that we had full access to all the study's data. The datasets used and analyzed during the current study are available from the corresponding author on reasonable request

Funding: This study was sponsored by the Moscow Center for Innovative Technologies in Healthcare.

Conflicts of interest: The authors have no conflicts of interest to declare.

Author contributions

M. Sh. Khubutiya: Concept/design, Critical revision of article, Approval of article

I. V. Dmitriev: Concept/design, Critical revision of article, Approval of article

N. S. Zhuravel: Concept/design, Data analysis/interpretation, Statistics, Data collection

A. G. Balkarov: Critical revision of article, Approval of article

R. V. Storozhev: Data analysis/interpretation, Data collection

Yu. A. Anisimov: Data analysis/interpretation, Statistics, Data collection

A. S. Kondrashkin: Data analysis/interpretation

N. V. Shmarina: Data analysis/interpretation

Acknowledgements: The authors gratefully acknowledge the technical support provided by the Moscow Center for Innovative Technologies in Healthcare for the preparing of this article.

Authors' information (optional):

Mogeli Sh. Khubutiya,Academician of the Russian Academy of Sciences, Prof., Dr. Sci. (Med.), President of N.V. Sklifosovsky Research Institute for Emergency Medicine; Head of the Department of Transplantology and Artificial Organs of the Scientific and Educational Institute "N.A. Semashko Higher School of Clinical Medicine", Russian University of Medicine, https://orcid.org/0000-0002-0746-1884, [email protected]

Ilya V. Dmitriev, Dr. Sci. (Med.), Head of the Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine; Associate Professor of the Department of Transplantology and Artificial Organs, N.I. Pirogov Russian National Research Medical University, https://orcid.org/0000-0002-5731-3310, [email protected]

Nikita S. Zhuravel, Cand. Sci. (Med), junior researcher, surgeon of Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine, Assistant Professor of the Department of Transplantology and Artificial Organs, Moscow State Medical and Dental University, https://orcid.org/0000-0002-0156-2107, [email protected]

Aslan G. Balkarov, Cand. Sci. (Med.), Head of the Scientific Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine; Associate Professor of the Department of Transplantology and Artificial Organs, N.I. Pirogov Russian National Research Medical University; Head of the Organizational and Methodological Department for Transplantology, Research Institute for Healthcare Organization and Medical Management, https://orcid.org/0000-0002-1396-7048, [email protected]

Roman V. Storozhev, surgeon of Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine, https://orcid.org/0000-0002-7953-8182, [email protected]

Yuri A. Anisimov, Cand. Sci. (Med), surgeon of Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine, Associate Professor of the Department of Transplantology and Artificial Organs, Moscow State Medical and Dental University, https://orcid.org/0000-0002-3041-7478, [email protected]

Alexander S. Kondrashkin, Cand. Sci. (Med), Deputy Chief Physician for Internal Quality Control of Medical Care of Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine, Associate Professor of the Department of Transplantology and Artificial Organs, Moscow State Medical and Dental University, https://orcid.org/0000-0003-3070-8440, [email protected]

Nonna V. Shmarina, Senior Researcher of Department of Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine, Associate Professor of the Department of Transplantology and Artificial Organs, N.I. Pirogov Russian National Research Medical University, https://orcid.org/0000-0002-8199-905X, [email protected]

World Health Organization. Diabetes. Available at https://www.who.int/ru/news-room/fact-sheets/detail/diabetes. (Accessed May 30, 2024.)
Dedov II, Shestakova MV, Vikulova OK, Zheleznyakova AV, Isakov MА. Epidemiological characteristics of diabetes mellitus in the Russian Federation: clinical and statistical analysis according to the Federal diabetes register data of 01.01.2021. Diabetes mellitus. 2021;24(3):204-221. (In Russ.) https://doi.org/10.14341/DM12759
Shestakova MV, Vikulova OK, Zheleznyakova AV, Isakov MA, Dedov II. Diabetes epidemiology in Russia: what has changed over the decade? Therapeutic Archive. 2019;91(10):4–13. (In Russ.) https://doi.org/10.26442/00403660.2019.10.000364
Shamkhalova MS, Vikulova OK, Zheleznyakova AV, Isakov MA, Shestakova MV, Dedov II. Trends in the epidemiology of chronic kidney disease in Russian Federation according to the Federal Diabetes Register (2013–2016). Diabetes mellitus. 2018; 1(3):160-169. (In Russ.) https://doi.org/10.14341/DM9687
Gruessner RW, Gruessner AC. The current state of pancreas transplantation. Nat Rev Endocrinol. 2013;9(9):555-562. https://doi.org/10.1038/nrendo.2013.138
Usova EV, Kaabak MM, Chzhao AV. Pancreas transplantation. Transplantologiya. The Russian Journal of Transplantation. 2015;(1):23-40. (In Russ.)
Boggi U, Vistoli F, Andres A, Arbogast HP, Badet L, Baronti W, et al. First World Consensus Conference on pancreas transplantation: Part II – recommendations. Am J Transplant. 2021;21 Suppl 3(Suppl 3):17-59. https://doi.org/10.1111/ajt.16750
Samoylova ML, Borle D, Ravindra KV. Pancreas transplantation: indications, techniques, and outcomes. Surg Clin North Am. 2019;99(1):87-101. https://doi.org/10.1016/j.suc.2018.09.007
Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967;61(6):827-837. PMID: 5338113
Sutherland DE, Gruessner RW, Dunn DL, Matas AJ, Humar A, Kandaswamy R, et al. Lessons learned from more than 1,000 pancreas transplants at a single institution. Ann Surg. 2001;233(4):463-501. https://doi.org/10.1097/00000658-200104000-00003
Blanc-Brunat N, Dubernard JM, Touraine JL, Neyra P, Dubois P, Paulin C, Traeger J. Pathology of the pancreas after intraductal neoprene injection in dogs and diabetic patients treated by pancreatic transplantation. Diabetologia. 1983;25(2):97-107. https://doi.org/10.1007/BF00250896
Lillehei RC, Simmons RL, Najarian JS, Weil R, Uchida H, Ruiz JO, et al. Pancreatico-duodenal allotransplantation: experimental and clinical experience. Ann Surg. 1970;172(3):405-436. https://doi.org/10.1097/00000658-197009000-00010
Sutherland DE. Pancreas and islet transplantation. II. Clinical trials. Diabetologia. 1981;20(4):435-450. https://doi.org/10.1007/BF00253405
Gliedman ML, Gold M, Whittaker J, Rifkin H, Soberman R, Freed S, et al. Clinical segmental pancreatic transplantation with ureter-pancreatic duct anastomosis for exocrine drainage. Surgery. 1973;74(2):171-180. PMID: 4577803
Gliedman ML, Tellis V, Soberman R, Rifkin H, Freed SZ, Veith FJ. Pancreatic transplantation in New York. Kidney Int Suppl. 1974;(1):164-168. PMID: 4619132
El-Hennawy H, Stratta RJ, Smith F. Exocrine drainage in vascularized pancreas transplantation in the new millennium. World J Transplant. 2016;6(2):255-271. https://doi.org/10.5500/wjt.v6.i2.255
Siskind EJ, Amodu LI, Pinto S, Akerman M, Jonsson J, Molmenti EP, Ortiz J. Bladder versus enteric drainage of exocrine secretions in pancreas transplantation: a retrospective analysis of the United Network for Organ Sharing Database. Pancreas. 2018;47(5):625-630. https://doi.org/10.1097/MPA.0000000000001043
Corry RJ, Chakrabarti P, Shapiro R, Jordan ML, Scantlebury VP, Vivas CA. Comparison of enteric versus bladder drainage in pancreas transplantation. Transplant Proc. 2001;33(1-2):1647-1651. https://doi.org/10.1016/s0041-1345(00)02626-9
Perosa M, Noujaim H, Ianhez LE, Oliveira RA, Mota LT, Branez JR, et al. Experience with 53 portal-duodenal drained solitary pancreas transplants. Clin Transplant. 2014;28(2):198-204. https://doi.org/10.1111/ctr.12297
Ferrer J, Molina V, Rull R, López-Boado MÁ, Sánchez S, García R, et al. Pancreas transplantation: advantages of a retroperitoneal graft position. Cir Esp. 2017;95(9):513-520. https://doi.org/10.1016/j.ciresp.2017.05.004
Spetzler VN, Goldaracena N, Marquez MA, Singh SK, Norgate A, McGilvray ID, et al. Duodenal leaks after pancreas transplantation with enteric drainage - characteristics and risk factors. Transpl Int. 2015;28(6):720-728. https://doi.org/10.1111/tri.12535
Sanjanwala SS, Thati VN, Rohondia OS, Rambhia SU. Comparison of operative procedures for re-leaks duodenal perforation: a cross-sectional analysis from a tertiary care hospital in a developing country. Int Surg J. 2016;3(3):1314–1317. https://doi.org/10.18203/2349-2902.isj20162230
Grochowiecki T, Gałązka Z, Madej K, Frunze S, Nazarewski S, Jakimowicz T, et al. Early complications related to the transplanted kidney after simultaneous pancreas and kidney transplantation. Transplant Proc. 2014;46(8):2815-2817. https://doi.org/10.1016/j.transproceed.2014.08.011
Kelly WD, Lillehei RC, Merkel FK, Idezuki Y, Goetz FC. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967; 61(6):827-835. PMID: 5338113
Kerr HR, Hatipoglu B, Krishnamurthi V. Pancreas transplant for diabetes mellitus. Cleve Clin J Med. 2015; 82(11):738–744. https://doi.org/10.3949/ccjm.82a.14090
Shokouh-Amiri H, Zakhary JM, Zibari GB. A novel technique of portal-endocrine and gastricexocrine drainage in pancreatic transplantation. J Am Coll Surg. 2011; 212(4):730-738. https://doi.org/10.1016/j.jamcollsurg.2010.12.045
Berger L, Bialobrzecka М, Schenker P, Wunsch A, Viebahn RL. Complications after pancreas transplantation. Transplantation. 2018; 102 (Suppl 7):S753. https://doi.org/10.1097/01.tp.0000543751.04757.43
Fox DE, Quinn RR, Ronksley PE, Harrison TG, Quan H, Bigam D, et al. Perioperative outcomes following kidney-pancreas transplantation in Alberta, Canada: research letter. Can J KidneyHealth Dis. 2021; 8: 20543581211029389. eCollection 2021 https://doi.org/10.1177/20543581211029389
Ferrer-Fàbrega J, Fernández-Cruz L. Exocrine drainage in pancreas transplantation: Complications and management. World J Transplant. 2020; 10(12):392-403. https://doi.org/10.5500/wjt.v10.i12.392
Boggi U, Vistoli F, Andres A, ArbogastHP, Badet L, BarontiW^, et al. First World Consensus Conference on pancreas transplantation: Part II – recommendations. Am J Transplant. 2021; 21(Suppl 3):17-59. https://doi.org/10.1111/ajt.16750

No competing interests reported.

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Retroperitoneal pancreas transplantation with a Roux-en-Y duodenojejunostomy for exocrine drainage

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