Table 4.
Bladder vs enteric drainage: Literature review
| Center, authors, year, ref., and study design | Number and type of transplant | Complication/enteric conversion | Acute rejection/graft loss | Reoperation and readmissions | 1 yr patient survival | 1 yr pancreas (and kidney) graft survival |
| University of Maryland, Kuo et al[35], Retrospective | 23 SPK ED | ED: Fewer UTIs and urologic complications | ND | ND | ED 100%; BD 96% | ED 88%; BD 91% |
| University of Chicago, Newell et al[33], Retrospective | SPK; ED 12; BD 12 | Acidosis and dehydration less with ED (P < 0.005); Hematuria; BD 25%; ED 0%; No anastomotic leaks in either group; No intra-abdominal infection in either group; Enteric conversion: 33% | ND | BD: 4 patients underwent enteric conversion | BD 100%; ED 83.3% | BD 91.7%; ED 83.3% |
| University of Wisconsin, Sollinger et al[80]; Retrospective | 1000 SPK; BD 390; ED 610 | Pancreas graft thrombosis; BD 2.3% ED 3.6%; Infection; BD 1.8% ED 0.8%; Pancreatitis; BD 1.3% ED 0.5%; Pancreatic leak BD: 12% ED: 5% (P = 0.06) | Kidney rejection; BD 29%; ED 19%; Pancreas rejection; BD 12.1%; ED 5.4% | ND | Similar in both groups | Similar kidney, and pancreas graft survival in both groups |
| Pirsch et al[37], Retrospective | 48 BD; 78 ED | Opportunistic infections; ED: 12% BD: 31% (P = 0.002); CMV; BD 21% ED 4% (P = 0.04); Fungal infection; BD 17% ED 4%; UTI BD 63% ED 20% (P = 0.0001) | Kidney rejection; BD 38%; ED 30%; Steroid-resistant rejection; BD 19%; ED 17% | |||
| University of Washington, Friedrich et al[90], Retrospective | 34; ED 17; BD 17 | ED 41%; BD 53%; Enteric conversion: 5% | ED 29%; BD 24% | Readmissions: ED 41%; BD 47% | ND | ND |
| University of Tennessee-Memphis, Stratta et al[41], Prospective | BD 16; ED 16 | UTI BD 50% ED 19%; Urologic complications; BD 25% ED 12.5%; Dehydration BD 100% ED 44% | BD 44%; ED 31% P = NS | BD 25%; ED 25%; Readmissions: BD 2.6 ± 1.8; ED 1.75 ± 1.2 | BD 88%; ED 94% | Kidney survival; BD 92%; ED 93%; Pancreas survival BD 81%; ED 88% |
| Albert Einstein Medical Center, Bloom et al[34], Retrospective | 71 SPK; BD 37; ED 34 | Dehydration BD 34% ED 3.4%; Acidosis BD 41% ED 0% Pancreatitis BD 40% ED 3.4% UTI BD 71% ED 27% (P < 0.005) Enteric conversion: 19% | BD: 13.5%; ED: 14.7% | Similar between groups | Pancreas allograft survival was similar between groups | |
| Emory University, Pearson et al[36], Retrospective | SPK; BD 55; ED 11 | BD; UTI 78%; Hematuria 27%; Dehydration 38%; ED no complication | ||||
| University of Pittsburgh Corry et al[43], Retrospective | BD 44; ED 199 | Overall BD 41% ED 26%; Anastomotic bleeding; BD 16% ED 5%; Fistula BD 14% ED 6% | BD 24%; ED 16% | BD 44%; ED 69% | ||
| Toronto General Hospital, Cattral et al[40], Retrospective | SPK; BD 20; ED 20 | UTI: Similar in both groups; CMV infections were significantly less in the ED group | BD 37%; ED 15%; (P = 0.20) | BD 1 patient to ligate an arteriovenous fistula in the pancreas graft; ED 4 patients; (bleeding in one, partial wound dehiscence in one, negative laparotomy in two) | BD 95%; ED 100% | Kidney graft survival; BD 95%; ED 100%; Pancreas graft survival; BD 95%; ED 100% |
| Wake Forest University, Stratta et al[46], Retrospective | 297 SPK; SE 171 (58%); PE 96 (32%); SB; 30 (10%) | No differences were seen in surgical complications including pancreas thrombosis; Infections: SE 49%; PE 85%; BD 63% | SE 19%; PE 26%; BD 30% | Readmissions: SE 61%; PE 63.5%; BD 63% | SE 97%; PE 99%; BD 97% | Kidney; SE 94%; PE 98%; BD 93%; Pancreas; SE 87%; PE 92%; BD 87% |
BD: Bladder drainage; ED: Enteric drainage; SB: Systemic-bladder; SE: Systemic-enteric; PE: Portal-enteric; UTI: Urinary tract infection; CMV: Cytomegalovirus; ND: Not determined/no data.