Advantages and disadvantages of urinary tract diversion in clinical pancreas transplantation.

T ^ H E METHOD of duct management that X is optimal for pancreatic (P) transplantation (Tx) continues to be a major controversy. An analysis of the Pancreas Transplant Registry shows no differences in results for the three major duct management techniques, polymer injection, enteric drainage, and urinary tract diversion (UTD). All techniques have advantages and disadvantages. Duct injection is safe but may lead to loss of the graft as a result of severe fibrosis. Enteric drainage is the most physiologic method but may lead to intra-abdominal infection. Neither duct injection nor enteric drainage allows for permanent monitoring of exocrine function.' These studies may be important, as the experimental studies indicate early involvement of the exocrine followed by the endocrine component in the rejection process. '̂̂ The methods of UTD are to anastomose the pancreatic duct of segmental grafts or the duodenum of whole pancreas graft to the renal pelvis, the ureter, or directly to the bladder."-'-^