Duodenoduodenostomy as an Attractive Option for Exocrine Drainage in Pancreas Transplantation: Insights From a Single-Center Cohort.

Alba Torroella, Rongrong Hu Zhu, Carlos Castillo-Delgado, Marco Pavesi, Ramón Rull, Emma Folch-Puy, Rocío García, Clara Bassaganyas, Carles Pérez-Serrano, Pedro Ventura-Aguiar, Enrique Montagud-Marrahi, Víctor Emilio Holguin, Antonio J Amor, Fritz Diekmann, Ángeles García-Criado, Juan Carlos García-Valdecasas, Josep Fuster, Joana Ferrer-Fàbrega

Journal: Transplant international : official journal of the European Society for Organ Transplantation 2025;38():15430

PMID: 41256736

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Abstract

Techniques such as retroperitoneal graft placement have further enhanced the ability to replicate the physiology of the "native" pancreas. In our center, from January 2000, duodenojejunostomy (DJ) was the standard technique for exocrine drainage (n = 337). Herein, we report a series of 188 pancreas transplantations performed between May 2016 to July 2025, using a fully retrocolic graft position, systemic venous drainage and enteric drainage via duodenoduodenostomy. The primary endpoint was the assessment of intestinal events and their impact on graft and patient survival. A total of 14 patients (7.4%) experienced complications, including paralytic ileus (n = 2), intestinal obstruction (n = 4), duodenal dehiscence following pancreas transplantectomy (n = 1), anastomotic dehiscence (n = 5), and anastomotic bleeding (n = 2). Of these, 11 cases required relaparotomy for adhesiolysis (n = 2), internal hernia repair (n = 1), Hartmann's procedure (n = 1), transplantectomy (n = 2), primary leak closure (n = 3), and hemostasis with duodenal re-anastomosis (n = 2). After a median follow-up of 42.8 months [IQR 21.8-71.1], graft survival at 1 and 5 years was 87% and 83.4%, respectively (P = 0.688 vs. DJ group), while patient survival was 100% and 98.2% (P = 0.031 vs. DJ group). Duodenoduodenostomy proved to be a feasible and effective technique, offering competitive outcomes in terms of graft and patient survival.

Copyright © 2025 Torroella, Zhu, Castillo-Delgado, Pavesi, Rull, Folch-Puy, García, Bassaganyas, Pérez-Serrano, Ventura-Aguiar, Montagud-Marrahi, Holguin, Amor, Diekmann, García-Criado, García-Valdecasas, Fuster, Ferrer-Fàbrega.

Address: Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Clinical Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic Barcelona, Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; Hepatobiliopancreatic Surgery and Abdominal Transplant Unit, Department of General Surgery, Hospital General Plaza de la Salud, Santo Domingo, Dominican Republic.; Barcelona Clinical Coordinating Center (BCCC) - Fundació Món Clínic, Barcelona, Spain.; Experimental Pathology Department, Institut d'Investigacions Biomèdiques de Barcelona-Consejo Superior de Investigaciones científicas (IIBB-CSIC), Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; Radiology Department, Hospital Clínic Barcelona, Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; Kidney Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clinic Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical, Research Institute (IDIBAPS), Barcelona, Spain.; Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Clinical Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic Barcelona, Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical, Research Institute (IDIBAPS), Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical, Research Institute (IDIBAPS), Barcelona, Spain.; Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; Radiology Department, Hospital Clínic Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical, Research Institute (IDIBAPS), Barcelona, Spain.; Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Clinical Institute of Digestive and Metabolic Diseases (ICMDiM), Hospital Clínic Barcelona, Barcelona, Spain.; University of Barcelona, Barcelona, Spain.; August Pi i Sunyer Biomedical, Research Institute (IDIBAPS), Barcelona, Spain.; Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain.

DOI: 10.3389/ti.2025.15430

MeSH Terms: Humans, Male, Female, Middle Aged, Adult, Duodenostomy, Pancreas Transplantation, Drainage, Graft Survival, Postoperative Complications, Retrospective Studies, Duodenum, Treatment Outcome, Anastomosis, Surgical, Aged, Young Adult