Bladder vs enteric drainage following pancreatic transplantation: How best to support graft survival? A best evidence topic.

A best evidence topic in transplant surgery was written according to a structured protocol. The question addressed was: In patients undergoing pancreatic transplantation alone, does enteric drainage or bladder drainage of exocrine secretions provide the best graft survival? A total of 155 papers were identified using the search protocol described, of which four retrospective cohort studies represented the best evidence available to answer the clinical question. The authors, journal, date and country of publication, study type, patient group studied, relevant outcomes and results of these papers are tabulated. Three of the four studies demonstrated no significant difference in graft survival between enteric drainage and bladder drainage at 6 months or 1 year. This included the largest and most recent study which showed that patient survival, graft survival and technical failure rates at 1 year were equal between the two duct management techniques. However, one study indicated lower graft survival at 1 year with enteric drainage due to a higher technical failure rate. Therefore, the clinical bottom line is that there is no significant difference in graft survival between enteric drainage or bladder drainage of pancreatic exocrine secretions for pancreas transplants alone. There is some evidence that enteric drainage may be associated with higher technical failure and higher graft rejection but this has not been universally demonstrated. Given the historical nature of all the available evidence, further appropriately powered and randomised Level 1 studies are necessary to clarify this important issue.