Controversy remains whether there is still a role for bladder drainage (BD) in pancreas transplantation. Compared to excellent results in simultaneous pancreas kidney transplantation, pancreas transplantation alone (PTA) is still hampered by an up to 20% graft loss within the first year post transplantation. Herein we report our recent experience with bladder drained PTA.

34 consecutive PTA performed between February 2010 and September 2012 were retrospectively reviewed. Re-transplantations were not included. All but 1 patient (previous total pancreatectomy for benign disease) suffered from type I diabetes. Induction immunosuppression consisted in two doses of Campath, maintenance immunosuppression in Tac and MMF. Exocrine enteric drainage (ED) was performed in half of the study cohort; the other half had exocrine BD.

Median follow up of the ED and the BD group was 23 months (range 0 – 33) and 12 months (1 – 19), respectively. Donor BMI was significantly lower in the BD group (n = 0.02). All other donor and recipient demographics were not significantly different. 1 year graft survival in the ED group was 64.7% (n = 6), 4 patients experiencing acute rejection (1 case of non-compliance), and 2 losses due to intraabdominal sepsis. In the BD group 1 year graft survival is 100% (p = 0.01). In this group grafts were monitored by urinary amylase levels. In 7 patients 9 episodes with a drop in urinary amylase higher than 50% correlated with either acute rejection diagnosed by duodenal biopsy or with partial thrombosis of the main graft vessels. Following three day course of methylprednisolone or therapeutic dose heparin administration, respectively, urinary amylase levels recovered back to their baselines. Number of readmitted patients (8/17 ED vs 11/17 BD; p=ns) as well as incidence of patients readmitted more than once (2/17 ED vs 6/17 BD; p=ns) were higher in the BD group, however, without reaching statistical significance. So far, three bladder drained patients necessitated conversion to ED.

Despite the higher incidence of readmissions, we observed significantly better short-term graft survival in bladder drained PTAs. One reason might be that close monitoring of the graft by urinary amylase prevents delays in treatment of early (non)immunological complications.

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