Long-Term Outcomes in Simultaneous Kidney-Pancreas Transplant Recipients With Portal-Enteric Versus Systemic-Bladder Drainage A. Lo, R.J. Stratta, D.K. Hathaway, M.F. Egidi, M.H. Shokouh-Amiri, H.P. Grewal, R. Winsett, J. Trofe, R.R. Alloway, and A.O. Gaber W ITH INCREASING experience, short-term patient and graft survival rates following simultaneous kid- ney-pancreas transplant (SKPT) have steadily improved in recent years. 1,2 However, long-term patient and graft sur- vival data have only been reported recently in the literature, and these studies have focused primarily on SKPT patients with bladder rather than enteric drainage of the exocrine secretions. 3–8 The impact of the differences in surgical techniques on long-term outcomes has not been extensively evaluated and compared. 6,8 The purpose of this study was to evaluate the influence of different duct and vascular management techniques, namely portal-enteric (P-E) ver- sus systemic-bladder (S-B) drainage, on long-term out- comes following SKPT. METHODS All SKPT patients transplanted at our center between January 1990 and January 1996 were evaluated for inclusion in the study. Patients were included if they were transplanted utilizing either the P-E or S-B technique, had functioning allografts at 1 year post- transplant, and had a minimum of 3 years of follow-up. Based on a review of inpatient and outpatient records, patient demographics, transplant and immunologic characteristics, and patient and graft survival rates were collected and analyzed. The length of hospital- ization, reasons for readmission, and kidney and pancreas functions were also evaluated and compared between the two groups. Cardiovascular complications including blood pressure, the need for antihypertensive agents, total cholesterol, and the need for antihyperlipidemic agents were assessed. Microvascular complica- tions including retinopathy, peripheral neuropathy, and autonomic dysfunction associated with diabetes were assessed at annual evaluations. Four quality of life surveys that provided 29 scores quantifying functional ability, health and well-being, psychoemo- tional status, and global assessment were completed 6 to 24 months (mean 18.5) after SKPT. RESULTS A total of 78 SKPT patients were evaluated for inclusion in the study. Forty-five patients (26 P-E, 19 S-B drainage), who were alive with functioning grafts 1 year after SKPT and had a minimum follow-up of 3.5 years (mean 5.9 years), were included in the study. Demographic, immunologic, and transplant characteristics were similar between the two groups (Table 1). All patients received OKT3 for induction and azathioprine and prednisone as maintenance immuno- suppression. In the P-E group, 48% of the patients received tacrolimus (TAC)-and 52% received cyclosporine (CSA, Sandimmune)-based therapy. In the S-B group, all of the patients received CsA, but 10% of the patients were switched to TAC at mean of 2 years posttransplant. At 5 years, there were no differences in the actual patient, kidney, and pancreas graft survival rates between the P-E and S-B groups, 92% vs 84%, 81% vs 79%, and 88% vs 74%, respectively (P = NS). The 10-year actuarial patient, kidney, and pancreas graft survival rates in the P-E group were 74%, 50%, and 53%, respectively, compared to 37%, 31%, and 32%, in the S-B group, respectively (Table 1). During the first year posttransplant, patients in the S-B group had more readmissions (62 readmissions, mean 3.2 readmissions/patient) than patients in the P-E group (45 readmissions, mean 1.7 readmissions/patient, P = .03). The most common reasons for hospital readmission in the P-E group were infection (29%), rejection (13%), surgery (11%), and dehydration (7%). The most common reasons for hospital readmission in the S-B group were infection (32%), dehydration (16%), surgery (13%), and rejection (11%). More patients in the S-B group were readmitted for urinary tract infection (6/19, 32%) than patients in the P-E group (3/26, 11%, P = .09). The incidence of readmission for dehydration was significantly higher in the S-B group (16%) compared to the P-E group (7%, P  .01). Renal and pancreas function remained stable and comparable be- tween the two groups. Patients in the S-B group received fewer antihypertensive agents than patients in the P-E group (mean 1.0 S-B vs 1.7 P-E) during the entire follow-up period, but no significant differences in the systolic, dia- stolic, and mean arterial blood pressures were observed between the two groups. At 5 years, patients in the P-E group experienced a slight decline in body weight. In From the Departments of Pharmacy (A.L., J.T., R.R.A.); Sur- gery (R.J.S., M.H.S.-A., H.P.G., R.R.A.); Nursing (D.K.H., R.W.), and Medicine (M.F.E.); University of Tennessee-Memphis, Mem- phis, Tennessee. Address reprint requests to Dr R.J. Stratta, Department of Surgery, University of Tennessee-Memphis, 956 Court Avenue, Suite A202, Memphis, TN 38163. 0041-1345/01/$–see front matter © 2001 by Elsevier Science Inc. PII S0041-1345(00)02640-3 655 Avenue of the Americas, New York, NY 10010 1684 Transplantation Proceedings, 33, 1684–1686 (2001)