In a consecutive series of 47 pancreatic
transplantations, the duct occlusion technique and the bladder drainage technique are evaluated. Major problems, when using the duct occlusion technique are pancreatic fistulae with
secondary infections and bleedings. Early postoperative graft
thrombosis remains a crucial problem. Finally, graft rejection can not be diagnosed in time when using the duct occlusion technique. In contrast, the bladder drainage technique guarantees an absolutely safe management of the exocrine pancreas secretion. The risk of early postoperative graft
thromboses reaches nearly zero. In addition, by monitoring urinary
amylase and thereby the function of the exocrine pancreas, rejection episodes can be diagnosed very early. Early postoperative
graft pancreatitis of the bladder drained pancreatic allografts remains a significant problem. In addition due to excessive
bicarbonate loss via the urine oral
bicarbonate substitution is necessary. A high incidence of
urinary tract infections as well as unspecific irritations of the urinary tract are further drawbacks of the bladder drainage technique. They can be managed, however, relatively easily. Since using the bladder drainage technique, 1-year-graft-function rate of the pancreatic allografts increased by more than 40% and reaches now 88%. The new operative technique represents the best
surgical procedure for control of the exocrine secretion of pancreatic allografts at the moment. Simultaneous pancreas-/
kidney transplantation in the technique described can therefore be recommended a selected group of type-I diabetics with
end-stage renal disease as the
therapy of choice.