A comparison of portal venous versus systemic venous drainage in pancreas transplantation
| Autor: | Joshua Stodghill, Ravinder K. Wali, Johann Jonsson, James Piper, Jorge Ortiz, Ernesto P. Molmenti, Chang Liu, Eric Siskind, Leo Amodu, Meredith Akerman |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Databases Factual medicine.medical_treatment Vena Cava Inferior Pancreas transplantation Young Adult 03 medical and health sciences Mesenteric Veins 0302 clinical medicine Risk Factors Humans Medicine In patient Young adult Retrospective Studies Hepatology Portal Vein business.industry Proportional hazards model Graft Survival Significant difference Gastroenterology Retrospective cohort study Venous drainage Femoral Vein Surgery Treatment Outcome surgical procedures operative medicine.anatomical_structure 030220 oncology & carcinogenesis Female Vascular Grafting 030211 gastroenterology & hepatology Pancreas Transplantation business Pancreas Liver Circulation |
| Zdroj: | HPB. 21:195-203 |
| ISSN: | 1365-182X |
| Popis: | Background The decision to utilize portal or systemic venous drainage in pancreas transplantation is surgeon- and center-dependent. Information regarding the superior method is based on single-center reports and animal models. Methods UNOS data on adults receiving pancreas and kidney-pancreas transplants from 1987 to 2016 were analyzed (n = 29 078). The groups analyzed were: systemic venous pancreas graft drainage (SVD, n = 24 512) or portal venous pancreas graft drainage (PVD, n = 4566). A Cox proportional hazard model compared patient and allograft survival between groups. Results No statistically significant differences were observed for patient and allograft survival at 1, 3, 5, 10, or 15 years post-transplant at each time interval and cumulatively (patient – HR:1.041; 95% CI:0.989–1.095; allograft – HR:0.951; 95% CI:0.881–1.027). PVD reduced the risk of death by 22.0% (P = 0.017) compared to SVD for patients undergoing pancreas after kidney transplant (PAK); no statistically significant difference was found for patients undergoing other types of transplants. Conclusion There is no significant clinical difference in patient or allograft survival between PVD and SVD in pancreas transplantation for the majority of patients. For the subgroup of PAK, PVD was associated with decreased mortality. For individual surgeons, center and patient scenarios should dictate which technique is performed. |
| Databáze: | OpenAIRE |
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