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Gastric Drainage: The United States Experience

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Transplantation of the Pancreas

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Abstract

Pancreas transplantation (PT) is an established treatment for patients with diabetes mellitus, with long-term graft and patient survival similar to other organ transplants. Among all treatment options available for patients with diabetes mellitus, a pancreas transplant gives the best glycemic control according to the Diabetes Control and Complications Trial (DCCT). However, the diagnosis of rejection has continued to be problematic in recipients of pancreas transplants. The systemic bladder technique allows the most reliable non-invasive mode of detecting acute pancreatic rejection, but it is associated with severe complications of electrolyte imbalance, dehydration, and irritative symptoms necessitating conversion to enteric drainage in 15–25% of patients. Portal-enteric pancreatic drainage via a duodenojejunostomy alleviates these complications but detection and diagnosis of pancreatic rejection are only possible with percutaneous biopsy (ultrasound or CT guided). In 2007, a novel technique of pancreas transplant with portal-endocrine and gastric-exocrine (P-G) drainage was first performed at our institution. This technique not only addresses the problems of dehydration and electrolyte imbalance by providing portal endocrine drainage but also allows lifelong access to the pancreas allograft for the detection of acute rejection. Since 2007, we have performed this technique for 119 diabetic patients with a comparable patient and allograft outcomes to other conventional techniques of pancreas transplantation.

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Authors and Affiliations

  1. John C. McDonald Regional Transplant Center, Willis-Knighton Health System, Shreveport, LA, USA

    Hosein Shokouh-Amiri & Gazi B. Zibari

Authors
  1. Hosein Shokouh-Amiri
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  2. Gazi B. Zibari
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Correspondence to Hosein Shokouh-Amiri .

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Editors and Affiliations

  1. Department of Surgery, State University of New York (SUNY), Downstate Health Sciences University, Brooklyn, NY, USA

    Rainer W. G. Gruessner

  2. Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY, USA

    Angelika C. Gruessner

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Shokouh-Amiri, H., Zibari, G.B. (2023). Gastric Drainage: The United States Experience. In: Gruessner, R.W.G., Gruessner, A.C. (eds) Transplantation of the Pancreas. Springer, Cham. https://doi.org/10.1007/978-3-031-20999-4_30

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  • DOI: https://doi.org/10.1007/978-3-031-20999-4_30

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-20998-7

  • Online ISBN: 978-3-031-20999-4

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