Portal versus systemic drainage of small bowel allografts: Comparative assessment of survival, function, rejection, and bacterial translocation

Thierry Berney, Tomoaki Kato, Seigo Nishida, A. Joseph Tector, Naveen K. Mittal, Juan Madariaga, Jose R. Nery, G. Patricia Cantwell, Philip Ruiz, Andreas G. Tzakis

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

BACKGROUND: Portal venous drainage of small bowel grafts is theoretically more physiologic than systemic drainage, but is technically more demanding. Comparisons in animal models have not demonstrated a clear advantage of one technique over the other, but clinical data are lacking. STUDY DESIGN: Clinical records of 36 patients who underwent 37 small bowel transplantation procedures from January 1995 to August 2001 were reviewed. Portal drainage was performed in 19 patients (PD group). Systemic drainage was performed in 18 patients (SD group). Median followup was 531 days. RESULTS: PD and SD patients had similar ICU stays (median 7 versus 9 days) and endotracheal intubation durations (median 3 versus 5 days). All current survivors, with the exception of one patient in each group, are independent from parenteral nutrition. Liver function tests were similar in both groups. There was a twofold increase in tacrolimus dosage in the PD group to achieve similar trough levels indicating a "first-pass" hepatic clearance effect. Cumulative incidence of acute rejection episodes and OKT3-requiring rejection episodes were similar in both groups. To the contrary, a lower incidence of gram-negative rods of Enterococcus sp. in blood or bronchoalveolar lavage suggested that the clearance of translocared intestinal bacteria was more efficient in the PD group. Graft and patient survival rates were similar in both groups. CONCLUSIONS: Systemic venous drainage of small bowel transplants is a dependable technique, associated with similar results as portal venous drainage, in terms of overall mortality, morbidity, rejection, function, and patient and graft survival. But attention should be paid to an impaired clearance of intestinal bacterial translocation after systemic drainage.

Original languageEnglish (US)
Pages (from-to)804-813
Number of pages10
JournalJournal of the American College of Surgeons
Volume195
Issue number6
DOIs
StatePublished - Dec 1 2002
Externally publishedYes

Fingerprint

Bacterial Translocation
Allografts
Drainage
Survival
Graft Survival
Transplants
Muromonab-CD3
Intratracheal Intubation
Liver Function Tests
Incidence
Parenteral Nutrition
Enterococcus
Tacrolimus
Bronchoalveolar Lavage
Survivors
Survival Rate
Animal Models
Transplantation
Morbidity
Bacteria

ASJC Scopus subject areas

  • Surgery

Cite this

Portal versus systemic drainage of small bowel allografts : Comparative assessment of survival, function, rejection, and bacterial translocation. / Berney, Thierry; Kato, Tomoaki; Nishida, Seigo; Tector, A. Joseph; Mittal, Naveen K.; Madariaga, Juan; Nery, Jose R.; Cantwell, G. Patricia; Ruiz, Philip; Tzakis, Andreas G.

In: Journal of the American College of Surgeons, Vol. 195, No. 6, 01.12.2002, p. 804-813.

Research output: Contribution to journalArticle

Berney, T, Kato, T, Nishida, S, Tector, AJ, Mittal, NK, Madariaga, J, Nery, JR, Cantwell, GP, Ruiz, P & Tzakis, AG 2002, 'Portal versus systemic drainage of small bowel allografts: Comparative assessment of survival, function, rejection, and bacterial translocation', Journal of the American College of Surgeons, vol. 195, no. 6, pp. 804-813. https://doi.org/10.1016/S1072-7515(02)01482-5
Berney, Thierry ; Kato, Tomoaki ; Nishida, Seigo ; Tector, A. Joseph ; Mittal, Naveen K. ; Madariaga, Juan ; Nery, Jose R. ; Cantwell, G. Patricia ; Ruiz, Philip ; Tzakis, Andreas G. / Portal versus systemic drainage of small bowel allografts : Comparative assessment of survival, function, rejection, and bacterial translocation. In: Journal of the American College of Surgeons. 2002 ; Vol. 195, No. 6. pp. 804-813.
@article{e4de8dd894aa4278ae314cbe39637bc2,
title = "Portal versus systemic drainage of small bowel allografts: Comparative assessment of survival, function, rejection, and bacterial translocation",
abstract = "BACKGROUND: Portal venous drainage of small bowel grafts is theoretically more physiologic than systemic drainage, but is technically more demanding. Comparisons in animal models have not demonstrated a clear advantage of one technique over the other, but clinical data are lacking. STUDY DESIGN: Clinical records of 36 patients who underwent 37 small bowel transplantation procedures from January 1995 to August 2001 were reviewed. Portal drainage was performed in 19 patients (PD group). Systemic drainage was performed in 18 patients (SD group). Median followup was 531 days. RESULTS: PD and SD patients had similar ICU stays (median 7 versus 9 days) and endotracheal intubation durations (median 3 versus 5 days). All current survivors, with the exception of one patient in each group, are independent from parenteral nutrition. Liver function tests were similar in both groups. There was a twofold increase in tacrolimus dosage in the PD group to achieve similar trough levels indicating a {"}first-pass{"} hepatic clearance effect. Cumulative incidence of acute rejection episodes and OKT3-requiring rejection episodes were similar in both groups. To the contrary, a lower incidence of gram-negative rods of Enterococcus sp. in blood or bronchoalveolar lavage suggested that the clearance of translocared intestinal bacteria was more efficient in the PD group. Graft and patient survival rates were similar in both groups. CONCLUSIONS: Systemic venous drainage of small bowel transplants is a dependable technique, associated with similar results as portal venous drainage, in terms of overall mortality, morbidity, rejection, function, and patient and graft survival. But attention should be paid to an impaired clearance of intestinal bacterial translocation after systemic drainage.",
author = "Thierry Berney and Tomoaki Kato and Seigo Nishida and Tector, {A. Joseph} and Mittal, {Naveen K.} and Juan Madariaga and Nery, {Jose R.} and Cantwell, {G. Patricia} and Philip Ruiz and Tzakis, {Andreas G.}",
year = "2002",
month = "12",
day = "1",
doi = "10.1016/S1072-7515(02)01482-5",
language = "English (US)",
volume = "195",
pages = "804--813",
journal = "Journal of the American College of Surgeons",
issn = "1072-7515",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Portal versus systemic drainage of small bowel allografts

T2 - Comparative assessment of survival, function, rejection, and bacterial translocation

AU - Berney, Thierry

AU - Kato, Tomoaki

AU - Nishida, Seigo

AU - Tector, A. Joseph

AU - Mittal, Naveen K.

AU - Madariaga, Juan

AU - Nery, Jose R.

AU - Cantwell, G. Patricia

AU - Ruiz, Philip

AU - Tzakis, Andreas G.

PY - 2002/12/1

Y1 - 2002/12/1

N2 - BACKGROUND: Portal venous drainage of small bowel grafts is theoretically more physiologic than systemic drainage, but is technically more demanding. Comparisons in animal models have not demonstrated a clear advantage of one technique over the other, but clinical data are lacking. STUDY DESIGN: Clinical records of 36 patients who underwent 37 small bowel transplantation procedures from January 1995 to August 2001 were reviewed. Portal drainage was performed in 19 patients (PD group). Systemic drainage was performed in 18 patients (SD group). Median followup was 531 days. RESULTS: PD and SD patients had similar ICU stays (median 7 versus 9 days) and endotracheal intubation durations (median 3 versus 5 days). All current survivors, with the exception of one patient in each group, are independent from parenteral nutrition. Liver function tests were similar in both groups. There was a twofold increase in tacrolimus dosage in the PD group to achieve similar trough levels indicating a "first-pass" hepatic clearance effect. Cumulative incidence of acute rejection episodes and OKT3-requiring rejection episodes were similar in both groups. To the contrary, a lower incidence of gram-negative rods of Enterococcus sp. in blood or bronchoalveolar lavage suggested that the clearance of translocared intestinal bacteria was more efficient in the PD group. Graft and patient survival rates were similar in both groups. CONCLUSIONS: Systemic venous drainage of small bowel transplants is a dependable technique, associated with similar results as portal venous drainage, in terms of overall mortality, morbidity, rejection, function, and patient and graft survival. But attention should be paid to an impaired clearance of intestinal bacterial translocation after systemic drainage.

AB - BACKGROUND: Portal venous drainage of small bowel grafts is theoretically more physiologic than systemic drainage, but is technically more demanding. Comparisons in animal models have not demonstrated a clear advantage of one technique over the other, but clinical data are lacking. STUDY DESIGN: Clinical records of 36 patients who underwent 37 small bowel transplantation procedures from January 1995 to August 2001 were reviewed. Portal drainage was performed in 19 patients (PD group). Systemic drainage was performed in 18 patients (SD group). Median followup was 531 days. RESULTS: PD and SD patients had similar ICU stays (median 7 versus 9 days) and endotracheal intubation durations (median 3 versus 5 days). All current survivors, with the exception of one patient in each group, are independent from parenteral nutrition. Liver function tests were similar in both groups. There was a twofold increase in tacrolimus dosage in the PD group to achieve similar trough levels indicating a "first-pass" hepatic clearance effect. Cumulative incidence of acute rejection episodes and OKT3-requiring rejection episodes were similar in both groups. To the contrary, a lower incidence of gram-negative rods of Enterococcus sp. in blood or bronchoalveolar lavage suggested that the clearance of translocared intestinal bacteria was more efficient in the PD group. Graft and patient survival rates were similar in both groups. CONCLUSIONS: Systemic venous drainage of small bowel transplants is a dependable technique, associated with similar results as portal venous drainage, in terms of overall mortality, morbidity, rejection, function, and patient and graft survival. But attention should be paid to an impaired clearance of intestinal bacterial translocation after systemic drainage.

UR - http://www.scopus.com/inward/record.url?scp=0036902416&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036902416&partnerID=8YFLogxK

U2 - 10.1016/S1072-7515(02)01482-5

DO - 10.1016/S1072-7515(02)01482-5

M3 - Article

C2 - 12495313

AN - SCOPUS:0036902416

VL - 195

SP - 804

EP - 813

JO - Journal of the American College of Surgeons

JF - Journal of the American College of Surgeons

SN - 1072-7515

IS - 6

ER -