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Pancreatic transplantation is able to produce euglycemia in patients with Type I diabetes mellitus. Current surgical techniques utilize revascularization of the graft through the recipient iliac vessels and drainage of the exocrine pancreatic secretions through a duodenal conduit into the bladder. We describe a technique utilized in 3 patients whereby venous pancreatic drainage is into the portal venous circulation via the proximal splenic vein. The exocrine pancreatic secretions are drained into the proximal jejunum via a side‐to‐side donor duodenum to proximal small bowel anastomosis. Results and complications of this technique are presented. Potential short‐term and long‐term advantages and disadvantages of this technique are discussed. Our early experience suggests that paratopic pancreatic transplantation with venous drainage into the portal vein and exocrine drainage into the proximal jejunum is both feasible and desirable.

Over a 26‐month period we assessed the ability of APACHE II, scored on admission to the surgical intensive care unit (SICU), to predict the in‐hospital mortality of liver and kidney transplant recipients either post‐operatively or after subsequent complications, and compared these results to non‐transplant SICU admissions. There were 866 SICU admissions, of which 128 were liver transplant recipients, 112 were renal transplant recipients, 211 were trauma admissions and 415 were non‐transplant/non‐trauma admissions. In hospital mortalities among all liver transplant admissions were 0%, 10%, 38%, and 82% for APACHE II ranges of 0‐10, 11‐20, 21‐30 and >30, respectively, with differences between the second and third, and third and fourth ranges significant (p≤0.05 by chisquare analysis). These differences were also seen when examining scores following the primary transplantation alone. Mortalities in corresponding APACHE II ranges for trauma and nontransplant/nontrauma admissions were similar. APACHE II scoring was not useful for renal transplant recipients, as it consistently overpredicted mortality. We conclude that APACHE II scoring may be useful in predicting outcome in post‐operative liver transplant recipients, but is not useful in stratifying risk in renal transplant recipients due to the inherently low mortality involved.

Since endogenous 1:25 vitamin D (1:25VD) is principally involved with involution of secondary hyperparathyroidism post‐renal transplant we correlated 1:25VD levels with intact PTH in 82 random patients with a serum creatinine of <2 mg/dl and with normal hepatic function. All patients studied were normocalcemic with normal phosphorus and received azathioprine, cyclosporin A and prednisone. Of considerable interest, of the 42 patients studied after 2 years post‐transplant, there were 8 (19%) patients with intact PTH of more than twice the upper limit of normal (normal 10‐65 pg/ml) and other 15 (36%) with PTH levels above normal. Secondly, in no patient did we see 1:25VD above normal (normal 15‐60 pg/ml) despite levels of PTH of >200 pg/ml. Of concern, 20% of 73 patients had 1:25VD deficiency (<15 pg/ml). This may not have been previously appreciated because of the number of patients studied. Like previous investigators, we failed to understand why 1:25VD levels were relatively low. There was no correlation between 1:25VD and serum creatinine. Of 25 patients with a serum creatinine of 1.4 or less, there were 10 patients (40%) with 1:25VD of less than 20 pg/ml. Since persistently high PTH can contribute to bone demineralization, which is not uncommon post‐transplant, we treated 8 patients with small doses of oral 1:25VD (rocaltrol). In less than 6 months PTH levels returned to normal in 7 of the 8 patients. The current studies clearly indicate that asymptomatic hyperparathyroidism is common even after 2 years post‐renal transplant. Monitoring for PTH and 1:25VD will help prevent bone disease posttransplant now that rocaltrol is available.