Backround: Different technical procedures have been developed successfully to perform pancreas transplantation (PT) with regard to exocrine drainage. Retroperitoneal graft placement behind the right colon allows exocrine drainage by direct side-to-side duodenoduodenostomy. This technique provides easy access of the graft for endoscopic hemostasis and rejection monitoring via endoscopic guided graft biopsy.

Methods: 241 pancreas transplantations (217 SPK, 17 PAK, 7 PTA) were performed at our center between 2002 and 2012. Out of 241 PT, Duodenoduodenostomy (DD) was performed in 125 patients and Duodenojejunostomy (DJ) was performed in 116 patients. In this retrospective analysis we compared our experience with these two types of enteric drainage, focused on graft-and patient survival as well as postoperative complications.

Results: Donor and recipient characteristics were similar except for recipient BMI (25.1vs.23.5 kg/m2) and duration of dialysis (37.5vs.32.1 months). Cumulative patient survival (DD vs. DJ) was 96% vs. 96.5% after 1year and 95% vs. 92% after 3 years (p= 0.62 ,log-rank test). Pancreas transplant survival after 1 and 3 years was 83% and 82% in DD-group and 78% and 73% in DJ-group without significant difference (p= 0.20). There were 13/125(10%) cases of pancreas graft loss in the DD-group and 21/116 (18.1%) in the DJ-group (p = 0.08). Relaparotomy rate was slightly higher in the DJ group (48.2%vs.41.6%), p=0.09.

Conclusion: DD is a feasible and safe technique in PT. It is equivalent to other established techniques and extends the possibility of anastomotic sites, especially in recipients who have underwent a second transplant. Further studies are required to confirm the benefits of a retroperitoneal graft position using DD.

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