***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: It has been shown that lipid profiles do not differ between pancreas recipients with systemic and portal venous anastomosis . However , it is unclear whether venous drainage from the transplanted pancreas has an impact on recipient atherogenesis and if other factors should be considered . Increased concentration of proinsulin correlates with tachycardia and other risk factors for ischemic heart disease . The aim of this study was to compare proinsulin levels in different types of pancreatic graft venous drainage . Twenty-four simultaneous pancreas and kidney transplantation ( SPK ) recipients with systemic venous drainage ( group S , n = 12 ) and portal venous drainage ( group P , n = 12 ) under identical immunosuppressive treatment were prospect ively observed during 24 months . Following transplantation , only recipients with normoglycemia , normal HbA1c , and normal serum creatine were evaluated . Proinsulin was assessed in fasting state ; after glucagon stimulation ( Delta-proinsulin ) , and during oral 75-g glucose tolerance test twice : between 3 and 6 months and 12 to 24 months posttransplantation . All SPK patients had higher proinsulin concentration in fasting state compared with age-matched healthy controls . After stimulation , proinsulin level did not significantly differ between groups ; the type of the pancreas venous anastomosis did not change the release of proinsulin and should not have impact on cardiovascular risk factors Abstract A r and omized study of combined kidney-pancreas transplantation was performed on 30 insulin-dependent diabetic patients with end-stage renal disease to compare the consequences of pancreas transplantation with portal venous ( PV ) and systemic venous ( SV ) drainage . Fourteen patients ( SV group ) received systemically drained and sixteen ( PV group ) portally drained pancreas allografts . Enteric drainage was performed in both groups . The routine follow-up included documentation of the clinical course and detailed endocrine studies . At 1 year after transplantation , the patient survival rate was 92 % for the SV group and 96 % for the PV group ; the graft survival rate was 78 % and 82 % , respectively . Endocrine studies indicated no difference in fasting and stimulated glucose or in glycosylated hemoglobin between the two groups . In addition , no hyperinsulinemia and lipidic abnormalities were evidence d in either group Long-term studies are required to conclude whether PV and SV drainage in pancreas transplantation are equivalent in terms of patient and graft survival as well as metabolic consequences BACKGROUND Most pancreas transplants are performed with systemic venous delivery of insulin and bladder drainage of the exocrine secretions ( systemic-bladder [ S-B ] ) . To develop a more physiologic procedure , we performed pancreas transplantations with portal venous delivery of insulin and enteric drainage of the exocrine secretions ( portal-enteric [ P-E ] ) . METHODS During an 11-month period , we prospect ively alternated 32 consecutive pancreas transplant recipients to either S-B ( n = 16 ) or P-E ( n = 16 ) drainage with st and ardized immunosuppression . RESULTS  Patient , kidney , and pancreas graft survival rates after simultaneous kidney-pancreas transplantation were 91 % S-B versus 92 % P-E , 91 % S-B versus 92 % P-E , and 82 % S-B versus 92 % P-E , respectively . Pancreas graft survival rates after solitary pancreas transplantation were 80 % S-B versus 75 % P-E. There were no graft losses either to immunologic or infectious complications in either group , but the incidence of acute rejection was slightly higher in the S-B group ( 44 % S-B vs 31 % P-E , P = NS ) . The cost and length of the initial hospital stay were similar between groups . The incidence of operative complications , major infections , and cytomegalovirus infections were likewise comparable . However , the S-B group was characterized by a slight increase in the number of readmissions , urinary tract infections , and urologic complications . Furthermore , metabolic acidosis and dehydration were more common in the S-B group . CONCLUSIONS Pancreas transplantation with P-E drainage can be performed with short-term results comparable to those of transplantation with S-B drainage Simultaneous pancreas‐kidney ( SPK ) transplantation is considered a valid therapeutic option for patient with type I diabetes mellitus and end‐stage diabetic nephropathy . This study was performed to determine whether the technique of pancreas venous drainage affects patient survival as well as graft survival and function . From October 1996 to April 1999 34 uremic patients with type I diabetes mellitus were r and omly assigned to two groups : the first group ( SV group=17 ) received SPK transplantation with systemic venous drainage , and the second group ( PV group=17 ) received pancreas allograft with portal drainage . A Roux‐en‐Y loop was performed in all the patients . Patient follow‐up included clinical course and metabolic studies . At 1 yr , patient survival rates were 88.2 % in the SV group and 94.1 % in the PV group while graft survival rate was 76.4 % in both groups . Several surgical complications were attributed to the enteric drainage without any graft failure in both groups . One venous thrombosis occurred in each group . No significant differences have been evidence d in kidney and pancreas function . The preliminary results of this r and omized trial did not evidence any significant differences between portal and systemic venous drainage of pancreas allograft Abstract : The impact of portal or systemic venous pancreas graft drainage on patient and  graft outcome remains controversial . In the present study , the impact of venous drainage type on long‐term patient and graft survival is assessed . From July 1996 to December 2002 80 simultaneous pancreas‐kidney transplants were enrolled into a prospect i ve study : 44 received a pancreas allograft with portal ( P‐SPK group )  and 36 with systemic venous drainage ( S‐SPK group ) .  Enteric exocrine drainage was performed in all recipients receiving the same immunosuppressive treatment . At one yr , the patient survival rates were 91.7 % and 95.5 % both for S‐SPK and P‐SPK groups , respectively ; no significant difference in survival was shown at any time point of the follow‐up . The one‐ , three‐ , five‐ , and eight‐yr pancreas survival rates were 75 % , 60.6 % , 56.7 % , and 44 % , respectively in the S‐SPK group compared to 88.6 % , 84.1 % , 78.4 % , and 31.3 % in the P‐SPK group . The one‐ , three‐ , five‐ , and eight‐yr kidney survival rates were 91.7 % , 78.15 % , 74.1 % , and 57.9 % , respectively in the S‐SPK group compared to 93.2 % , 88.6 % , 78.4 % , and 38.9 % in the P‐SPK group . Comparing the two groups , no significant difference was shown in the total number of surgical complications as well as in the number of each complication . No significant difference in long‐term outcomes between the two groups was shown , even if in S‐SPK group a higher incidence of pancreas graft loss has been reported and it was in part correlated to a higher number of graft thromboses Objective To test the hypothesis that pancreas transplantation  using the more physiologic method of portal venous-enteric ( PE ) drainage could be performed without compromising patient and graft outcome , compared with the st and ard method of systemic venous-bladder ( SB ) drainage . Methods Between November 1995 and November 1998 , the authors prospect ively followed up 20 consecutive patients with SB drainage followed by 20 consecutive patients with PE drainage . All patients underwent simultaneous pancreas – kidney transplantation , and all were immunosuppressed with antilymphocyte serum , cyclosporin , azathioprine , and steroids .  Results The actuarial patient survival rate at 1 year was 95 % in the SB group and 100 % in the PE group . Death-censored kidney graft survival was 100 % in both groups ; pancreas graft survival was 95 % in the SB group and 100 % in the PE group . The mean initial hospital stay was 15 days for both groups . However , during the first 6 months after transplantation , the SB group required more medical day-unit visits , mostly for treatment of metabolic acidosis and dehydration . The incidence of urinary tract infections was similar in both groups . The incidence of cytomegalovirus infections was significantly less in the PE group . The incidence of acute rejection was 37 % in the SB group and 15 % in the PE group . Mean serum creatinine levels 6 months after transplantation were significantly lower in the PE group than in the SB group . Glycemic control was excellent in both groups , but fasting serum insulin levels were significantly lower in the PE group . Conclusions The PE method of pancreas transplantation can be performed with excellent patient and graft outcomes Since 1995 , many centers have switched from bladder to enteric drainage of the exocrine secretions in simultaneous kidney-pancreas transplantation ( SKPT ) . Enteric exocrine drainage may be performed with either systemic ( systemic-enteric [ S-E ] ) or portal ( portal-enteric [ P-E ] ) venous delivery of insulin . Controversy exists regarding the optimal surgical technique . From March 1999 to May 2001 , a total of 297 SKPT patients were enrolled into a prospect i ve , multicenter , r and omized , open-label , comparative trial of two daclizumab dosing strategies versus no-antibody induction in combination with tacrolimus , mycophenolate mofetil , and steroids in SKPT recipients . Surgical techniques were center specific . A total of 171 patients ( 58 % ) underwent SKPT with S-E drainage , 96 ( 32 % ) with P-E drainage , and 30 ( 10 % ) with systemic-bladder ( S-B ) drainage . The two groups r and omized to daclizumab induction were similar with regard to surgical technique ( 64 % S-E , 25 % P-E , 11 % S-B drainage ) . Demographic and transplant characteristics and immunosuppression were similar among the three groups , except that more patients with P-E drainage did not receive antibody induction . At 6 months , no differences were seen in patient and graft survival rates , surgical complications including pancreas thrombosis , rates of rejection or infection , readmissions , and kidney and pancreas allograft function among the three different surgical techniques . The 6-month results of this multicenter study suggest no significant differences in outcomes in SKPT recipients according to surgical technique Objective To compare pancreas transplantation with systemic-enteric ( SE ) versus portal-enteric ( PE ) drainage in a prospect i ve fashion . Summary Background Data To improve the physiology of pancreas transplantation , the authors developed a new technique of portal venous delivery of insulin and enteric drainage of the exocrine secretions . Methods During a 26-month period , the authors prospect ively alternated 54 consecutive simultaneous kidney and pancreas transplants to either SE ( n = 27 ) or PE ( n = 27 ) drainage . The two groups were well matched for numerous characteristics . Maintenance immunosuppression in both groups consisted of tacrolimus , mycophenolate mofetil , and steroids . Results Patient survival rates were 93 % SE versus 96 % PE ; kidney graft survival rates were 93 % in both groups . Pancreas transplantation survival ( complete insulin independence ) was 74 % after SE versus 85 % after PE drainage with a mean follow-up of 17 months . The mean length of initial hospital stay was 12.4 days in the SE group and 12.8 days in the PE group . The SE group was characterized by a slight increase in the number of readmissions . The incidences of acute rejection ( 33 % ) and major infection ( 52 % ) were similar in both groups . The incidence of intraabdominal infection was slightly higher in the SE group . However , the early relaparotomy rate was similar between groups . The composite endpoint of no rejection , graft loss , or death was attained in 56 % of SE versus 59 % of PE patients . Conclusions These results suggest that simultaneous kidney and pancreas transplantation with SE or PE drainage can be performed with comparable short-term outcomes OBJECTIVE To determine the long-term effect of a functioning pancreas transplant on peripheral vasculopathy . DESIGN We compared the progression of peripheral vascular disease in 39 recipients of successful kidney-pancreas transplants ( KPT ) with 65 consecutive diabetic patients who received cadaver kidney transplants alone ( KTA ) during the same period in a nonr and omized , retrospective control study . The mean duration of follow-up was more than 4 years in both groups . SETTING Academic subspecialty referral practice 
    Output:
    
Based on this systematic review and meta- analysis , there is no evidence of differences in outcomes or metabolic control in patients undergoing pancreatic transplant with portal venous drainage compared to the systemic venous drainage