Introduction: Immunological monitoring of Pancreas Transplants Alone (PTA) remains a challenge and bladder drainage is thought to facilitate early detection of rejection but may lead to significant metabolic complications with uncertain impact on graft survival.

Methods: A single-centre analysis of 30 consecutively performed PTA over a 3 year period by interrogating a prospectively maintained database.

Results: All patients included had DM type I with severe hypoglycemia unawareness. Median age was 46 y (range 28-65) with a median BMI of 23.8 (range 18-32). 37% of the cohort was male. 28 patients had their first PTA. Donor median age was 33 y (range 2-59) with 20 (67%) being deceased brain dead. Immunosuppression included Alemtuzumab induction and mantainance with Tacrolimus with Mycophenolate. Median admission creatinine was 83 mmol/L (range 52-160). All patients had intraperitoneal graft placement with a porto-caval anastomosis and bladder drainage. Median hospital stay was 14 d (range 8-44). At discharge median fasting and two hour blood sugars during an OGTT were 5.2 and 7 mmol/L respectively. Median urinary amylase was 22,630 U/L (range 4,112-78,013). 30 % of patients were reoperated, for bleeding (n=8) or collection (n=2). 10 patients showed partial or occlusive thrombus. All were anticoagulated and only one graft was lost. Graft loss (13.3%) occurred in 4 cases with graft pancreatectomy in 3 of them (10%), at 3 w, 9 m and 15 m respectively. Rejection was treated with steroids in 5 cases (17%). Each recipient was readmitted at least once (range 0-8), predominantly for dehydration (47%). 56.7% of the patients had conversion to enteric drainage at 11 m (range 3.2-25.9). Median follow up (fu) was 16 m (range 0.3-37). One patient died (3%) at 4 m fu with a functioning graft. Median creatinine at fu was 98 mmol/L (range 55-225). One patient needed a kidney transplant.

Conclusion: In our experience, bladder drained PTA results in a temporary decline of native renal function in 50% of the patients. Readmission rates and partial thrombosis were high, but 90% of grafts were saved with anticoagulation. Planned enteric conversion may be reasonable around 12 m.

« Back to 2015 American Transplant Congress