125 Cases of duodenoduodenostomy in pancreas transplantation: a single-centre experience of an alternative enteric drainage.

Several exocrine drainage procedures have been successfully developed to perform pancreas transplantation (PT). Retroperitoneal graft placement allows exocrine drainage via direct duodenoduodenostomy (DD). This technique provides easy access for endoscopic surveillance and biopsy. A total of 241 PT procedures were performed in our centre between 2002 and 2012. DD was performed in 125 patients, and duodenojejunostomy (DJ) in 116 patients. We retrospectively compared our experience with these two types of enteric drainage, focusing on graft and patient survivals, as well as postoperative complications. With a mean follow-up of 59 months, both groups demonstrated comparable patient and graft survivals. 14 (11%) of 125 cases in the DD group and 21 (18%) of 116 cases in the DJ group had pancreatic graft loss (P = 0.142). Graft thrombosis [5 (4%) vs. 18 (16%) P = 0.002], anastomotic insufficiency [2 (1.6%) vs. 8 (7%) P = 0.052] and relaparotomy [52 (41%) vs. 56 (48%) P = 0.29] occurred more frequently in the DJ group, whereas gastrointestinal bleeding [14 (11%) vs. 4 (3%) P = 0.026] occurred more often in the DD group. DD is a feasible and safe technique in PT, with no increase in enteric complications. It is equivalent to other established techniques and extends the feasibility of anastomotic sites, especially in recipients who have undergone a second transplantation.

Single-dose thymoglobulin induction in living-donor renal transplantation.

BACKGROUND: The use of Thymoglobulin induction therapy in living-donor renal transplantation remains controversial. We aimed to evaluate outcomes in living-related donor (LRD) and living unrelated donor (LURD) renal transplants with Thymoglobulin induction. MATERIAL/METHODS: We retrospectively analysed the outcome of all Thymoglobulin induced living-donor renal transplants performed at our centre from 2002 to 2010. RESULTS: We reviewed 100 living-donor renal transplants (LRD=60; LURD=40) who received thymoglobulin induction (single dose, 1.5 mg/kg bodyweight) with a mean follow-up of 52.6 ± 31.9 months. Although baseline characteristics of the LRD and LURD groups were similar, differences were noted for recipient age, gender, and HLA-matching. Overall, the estimated 5-year patient survival was 92% and graft survival, 83%. The 1- and 5-year patient survival rates were 97.4% and 90.7% for LRD and 98.3% and 92.2% for LURD (P=0.79), respectively. Cumulative graft survival (LRD vs. LURD) rates were 93% vs. 95% after 1 year and 80% vs. 88% after 5 years (P=0.53). Kidney graft function was comparable for both the groups. Acute rejection was observed in 17% LRD and 35% LURD patients (P=0.035). Further, 10% of the patients experienced delayed graft function (LRD 11% vs. LURD 8%; P=NS). Rates of cytomegalovirus (CMV) infection (10%), polyomavirus infection (5%), malignancy (4%), and lymphoproliferative disorder (0%) were low, with no differences between the 2 groups. CONCLUSIONS: Single-dose thymoglobulin induction in living-donor renal transplantation was associated with high patient and graft survival without increasing the risk of infections or malignancy and without significant differences between LRD and LURD patients.