Abstracts
2000 Digestive Disease Week

# 2303 Simultaneous Kidney-Pancreas Transplantation with Enteric Exocrine Drainage: A Prospective Comparison of Systemic Versus Portal Venous Delivery of Insulin.
Robert J. Stratta, Mohammed H. Shokouh-Amiri, Hani P. Grewal, Maria F. Egidi, Tarik A. Kizilisik, Lillian W. Gaber, Ahmed O. Gaber, Memphis, TN

The results of pancreas transplantation (PTX) continue to improve due to advances in surgical techniques and immunosuppression. Although renewed interest has occurred in enteric exocrine drainage, most PTXs are performed with systemic venous delivery of insulin (systemic-enteric [SE]). To improve the physiology of PTX, a new surgical technique was developed with portal venous delivery of insulin and enteric exocrine drainage (portal-enteric [PE]). The purpose of this study was to compare PTX with SE vs PE drainage in a prospective fashion. Over a 16-month period, we alternately performed either SE (N=18) or PE (N=18) drainage in 36 consecutive simultaneous kidney-PTXs (SKPTs). The two groups were well matched for donor and recipient demographic, immunologic, dialysis, diabetes, and transplant characteristics. Maintenance immunosuppression in both groups consisted of tacrolimus, mycophenolate mofetil, and steroids. No antibody induction therapy occurred in about half of patients in each group, with the remainder equally divided between daclizumab and basiliximab adjuvant therapy. Results: Patient and kidney graft survival rates are 94% in both groups. One early death occurred in each group (both with functioning grafts). All but 1 kidney graft (PE group) had immediate function. PTX survival (complete insulin independence) is 89% in both groups with a mean follow-up of nearly 1 year (minimum 3 months). There was 1 non-immunologic pancreas graft loss in each group, but no grafts were lost to thrombosis. The mean length of initial hospital stay was 12 days in the SE and 14 days in the PE groups, respectively. The SE group was characterized by a slight increase in the number of readmissions (mean 2.5 SE vs 1.4 PE, P=NS). The incidence of major infection was similar (61% SE vs 50% PE), as was the relaparotomy rate (28% SE vs 33% PE). There was 1 CMV infection (6%) in the SE group. The incidence of intra-abdominal infection and enteric leaks was slightly higher in the SE group (28% SE vs 11% PE, P=NS). However, the need for prolonged vascular access was comparable (33% SE vs 28% PE). Mean hospital charges were comparable between groups (,102 SE vs ,685 PE). The composite endpoint of no readmission, no re-operation, and no rejection was equally attained by four patients (22%) in each group. Conclusions: These preliminary results suggest that SKPT with SE and PE drainage can be performed with comparable short-term outcomes.