ORIGINAL RESEARCH
Transpl. Int.
Duodenoduodenostomy as an attractive option for exocrine drainage in pancreas transplantation: insights from a single-center cohort
Alba Torroella 1
Rongrong H u Zhu 1
Carlos Castillo-Delgado 2
Marco Pavesi 3
RULL, R 1
Emma Folch 4
Rocío García 1
Clara Bassaganyas 5
Carles Pérez 5
Pedro Ventura-Aguiar 6,7
Enrique Montagud-Marrahi 6
Víctor Emilio Holguín 1
Antonio J. Amor 8,7
Fritz Diekmann 6,7
Ángeles García-Criado 5
Juan Carlos García-Valdecasas 1,9
Josep Fuster 1,9
Joana Ferrer-Fàbrega 1,7,9,10
1. Hepatobiliopancreatic Surgery and Liver and Pancreatic Transplantation Unit, Department of Surgery, Hospital Clinic de Barcelona Institut Clinic de Malalties Digestives i Metaboliques, Barcelona, Spain
2. Hepatobiliopancreatic Surgery and Abdominal Transplant Unit, Department of General Surgery, Hospital General de la Plaza de la Salud, Santo Domingo, Dominican Republic
3. Barcelona Clinical Coordinating Center (BCCC), Barcelona, Spain
4. Institut d'Investigacions Biomediques de Barcelona, Barcelona, Spain
5. Hospital Clinic de Barcelona Servei de Radiodiagnostic, Barcelona, Spain
6. Hospital Clinic de Barcelona Servei de Nefrologia i Trasplantament Renal, Barcelona, Spain
7. Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain
8. Diabetes Unit, Department of Endocrinology and Nutrition, Hospital Clinic de Barcelona Institut Clinic de Malalties Digestives i Metaboliques, Barcelona, Spain
9. Universitat de Barcelona, Barcelona, Spain
10. Network for Biomedical Research in Hepatic and Digestive Diseases (CIBERehd), Barcelona, Spain, Barcelona, Spain
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Abstract
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.
Summary
Keywords
pancreas transplantation, graft survival, exocrine drainage, duodenoduodenostomy, intestinalcomplications
Received
13 August 2025
Accepted
20 October 2025
Copyright
© 2025 Torroella, u Zhu, Castillo-Delgado, Pavesi, R, Folch, García, Bassaganyas, Pérez, Ventura-Aguiar, Montagud-Marrahi, Holguín, Amor, Diekmann, García-Criado, García-Valdecasas, Fuster and Ferrer-Fàbrega. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Joana Ferrer-Fàbrega, joferrer@clinic.cat
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