Fig. 7.7. Pancreaticoduodenal allograft with exocrine enteric-drainage and portal venous drainage.

The options of enteric versus bladder drainage depend on the choice of venous drainage and the clinical scenario of the pancreas transplant. For portally drained pancreas transplants, bladder drainage is not an option. For recipients of an SPK transplant, enteric drainage is the technique of choice because there is no urinary monitoring benefit and the morbidities as described above are significant. In the cases of PAK and PTA, bladder drainage has two important advantages: i.) urinary monitoring for rejection; and ii.) placement of the graft allowing access for percutanious biopsy for diagnosis of rejection. In the latter situations, the advantages of monitoring outweigh the morbidities associated with bladder drainage, at least in the short-term when the risk of immunologic graft loss is significant.

When the pancreas transplant is performed simultaneously with a kidney transplant, it is not uncommon for the kidney transplant to be implanted first. The

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