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

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.