WHOLE GLAND Portal Drainage of Pancreas Allograft: Surgical Complications and Graft Survival M. Dawahra, P. Petruzzo, N. Lefranc ¸ ois, C. Thivolet, L. Badet, J.M. Dubernard, and X. Martin C OMBINED pancreas– kidney transplantation has be- come generally accepted as an effective treatment option for type I diabetes as consequence of improved surgical techniques and advances in immunosuppression. Despite the positive results, surgical complications remain an important source of morbidity and graft loss. Several studies have reported surgical complications after pancreas transplantation with systemic-bladder drainage, 1 or with portal enteric drainage. 2 In a previous randomized study 3 we compared pancreas transplantation using portal venous drainage with systemic venous drainage. In the present study we compare the surgical complications and readmission rate as well as patient and graft survival after simultaneous pancreas– kidney transplantation using these two procedures. MATERIALS AND METHODS Over a 4-year period we performed 47 simultaneous pancreas– kidney (SPK) transplantations: 27 recipients received a pancreas allograft with portal venous drainage (PV group), and 20 recipients were given systemic venous drainage (SV group). In all patients enteric drainage of exocrine secretions was performed. SPK trans- plantation was performed in both groups using the standard technique developed at our center. 3 Briefly, the whole organ pancreas was transplanted into the right iliac vessels with end-to- side vascular anastomoses in the SV group, whereas in the PV group, the portal vein of the pancreas graft was anastomosed end-to-side to a major tributary of the superior mesenteric vein. The donor iliac artery bifurcation graft was anastomosed end-to- side to the right common iliac artery. In both groups the trans- planted duodenum was anastomosed to a diverting Roux-en-Y limb of the recipient jejunum. The renal allografts were anasto- mosed end-to-side to the left iliac vessels. This randomized study included 47 (27 men and 20 women) diabetic patients with end-stage renal disease; mean age in the PV group was 40.07  6.9 years and 45.85  6.0 years in the SV group. All recipients received an immunosuppressive protocol that in- cluded steroids, cyclosporine, and mycophenolate mofetil with antilymphocyte induction therapy. The follow-up period ranged from 3 months to 4 years. RESULTS Seven surgical complications (25.9%) requiring re-lapa- ratomy occurred in the PV group as well as in the SV group (35%). Indications for relaparatomy in the PV group included 1 venous thrombosis, 3 bowel occlusions, 1 intes- tinal leak, and 2 intraabdominal bleedings, and in the SV group were 2 venous thromboses, 2 bowel occlusions, 1 intestinal leak, 1 pancreatic abscess, and 1 intraabdominal bleeding. Except for one bowel occlusion occurring 36 months posttransplantation in the PV group, all surgical complications occurred in the first 3 months postoperatively in both groups. Patient survival rates at 1 and 4 years after transplantation were 92.6% in the PV group (1 cardiac arrest and 1 bleeding) and 90% (1 cardiac arrest and 1 septic shock) in the SV group; all patients who expired in both groups died within the first postoperative month. Pancreas survival rate was 85.9% in the PV group, with 7.4% of the graft losses due to surgical complications, and 75% in SV group, with 15% of the graft losses due to surgical complications. From the Service de Transplantation, Ho ˆ pital Edouard Herriot, Lyon, France. Address reprint requests to Dr M. Dawahra, Service de Trans- plantation, Ho ˆ pital Edouard Herriot, Place d’Arsonval, 69437 Lyon, France. © 2002 by Elsevier Science Inc. 0041-1345/02/$–see front matter 655 Avenue of the Americas, New York, NY 10010 PII S0041-1345(01)02922-0 Transplantation Proceedings, 34, 817– 818 (2002) 817