Background: In simultaneous kidney-pancreas transplantation (SPK), bladder (BD) and enteric (ED) are both options for pancreaticoduodenal exocrine drainage. While BD provides good early and long term SPK survival, it is associated with metabolic, urological and pancreatic complications leading to need for enteric conversion (EC). We report our single center experience in SPK patients (pts) who underwent EC after initial BD.

Methods: Between 1990 and 2019, we performed 541 SPK, of which 474 were BD and 67 were ED. We retrospectively studied pts who underwent EC. Indications for EC, time from SPK to EC, resolution of symptoms, complications and pancreas graft survival were analyzed.

Results: 56/474 pts underwent EC (11.8%). The mean time to EC was 4.5 years (yrs) (median 2.58 yrs) with intervals <1 yr = 19(33.9%), 1-5 yrs =20(35.7%), 5-10yrs=7(12.5%), 10-20 yrs =10 (17.8%) . The main indication for EC was dehydration followed by recurrent urinary tract infections (UTI). 4/11 (36.4%) pts who had EC due to UTI had persistent UTI, 7/11 (63.6%) had resolution of UTI; the rest of the pts had complete resolution of the primary indication.

6 (10.7%) pts had surgical complications post EC and 4 required re-exploration with ileoduodenostomy (bailout) operation for duodenal leak. Graft rejection was observed in 3 pts (5.3%) after EC and all were done 6-12 months post-transplant. The mean follow-up after EC was 5.7 yrs (median 4.25 yrs). Overall pancreas graft loss (GL) occurred in 7 pts (12.5%) after EC, including 2 pancreatectomies: 1 for duodenal fistula and 1 for gastrointestinal bleed. The mean interval between EC and GL was 4.1 yrs.

Conclusion: In this single center review of SPK pts with initial BD, the rate of EC was low at 11.8%. Persistent UTI post EC may be due to diabetes-related bladder dysfunction and in isolation should not lead to EC. BD may still be considered as primary drainage in SPK if indicated with the caveat of possible reoperation for EC.