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Bladder Drainage of Pancreas Transplants Alone: Friend or Foe?

M. Bellini,1 G. Spoletini,2 S. Reddy,1 J. Gilbert,1 I. Quiroga,1 R. Ploeg,1 E. Sharples,3 S. Sinha,1 A. Vaidya,1 P. Friend.1

1Nuffield Department of Surgery, Oxford University Hospital NHS Trust, Oxford, United Kingdom
2Department of Hepatobiliary and Transplant Surgery, Royal Free London NHS Trust, London, United Kingdom
3Nuffield Department of Medicine, Oxford University Hospital NHS Trust, Oxford, United Kingdom.

Meeting: 2015 American Transplant Congress

Abstract number: B285

Keywords: Graft survival, Metabolic complications, Pancreas transplantation, Post-operative complications

Session Information

Session Name: Poster Session B: Vascularized Composite Tissue Allografts and Xenotransplantation

Session Type: Poster Session

Date: Sunday, May 3, 2015

Session Time: 5:30pm-6:30pm

 Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

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.

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To cite this abstract in AMA style:

Bellini M, Spoletini G, Reddy S, Gilbert J, Quiroga I, Ploeg R, Sharples E, Sinha S, Vaidya A, Friend P. Bladder Drainage of Pancreas Transplants Alone: Friend or Foe? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/bladder-drainage-of-pancreas-transplants-alone-friend-or-foe/. Accessed May 9, 2025.

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