Exocrine Drainage of the Transplanted Pancreas: A Review

Pancreas transplant is an important treatment option for insulin dependent diabetic patients as it may result in physiologic euglycemia. Improvements in surgical technique, graft preservation, immunosuppression, diagnosis and management of rejection, and management of post-transplant complications have led to improved patient survival. There are several technical variables to consider when performing a pancreas transplant. One is the type of exocrine drainage to be used. The most common types of exocrine drainage are enteric or bladder drainage. Gastric-exocrine drainage has also been recently introduced. The most commonly cited complications for bladder drainage include metabolic complications, urologic complications and the need for enteric conversion. Many complications related to bladder drainage can be managed non-operatively with Foley catheter drainage. For those complications that cannot be managed in this manner enteric conversion is an option. For enteric drainage complications include anastomotic leak and intra-abdominal abscess, although at rates lower than cited in early literature on the topic. Bladder drainage of exocrine secretions and enteric drainage of exocrine secretions, or a staged procedure with bladder drainage followed by indicated or elective enteric conversion are reasonable options for drainage of the exocrine secretions of the pancreas. Gastric-exocrine drainage is a promising therapy for future exploration.