Kidney-Pancreas Transplants: Is It So Difficult to Start a Program?

• Published in: Transplantation proceedings 2005-04, Vol.37 (3), p.1455-1456
• Main Authors: Alonso, A., Fernández, C., Villaverde, P., Garcı́a, R., Aguirrezabalaga, J., Gómez, M., Oliver, J., Valdés, F.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; C-Peptide - blood; Cytomegalovirus Infections - epidemiology; Diabetes Mellitus, Type 1 - surgery; Diabetic Nephropathies - surgery; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Graft Rejection - epidemiology; Graft Survival - physiology; Hematoma - surgery; Humans; Immunosuppression - methods; Kidney Failure, Chronic - etiology; Kidney Failure, Chronic - surgery; Kidney Transplantation - immunology; Kidney Transplantation - physiology; Male; Medical sciences; Pancreas Transplantation - immunology; Pancreas Transplantation - physiology; Postoperative Complications - epidemiology; Reoperation; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Time Factors; Tissue, organ and graft immunology
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2005.02.004

For selected patients with type 1 diabetes mellitus and end-stage renal failure, simultaneous kidney-pancreas (SKP) or pancreas after kidney (PAK) transplantation is the treatment of choice. However, it is frequently difficult to start a program for fear of serious intraabdominal complications in an immunosuppressed patient. We review our initial experience with these transplantations. Twenty-three patients (20 SKP, 3 PAK) with type 1 diabetes mellitus received transplants between June 2000 and October 2003. All received immunosuppression therapy with thymoglobulin, prednisone, tacrolimus, and mycophenolate mofetil. The operation included portal venous drainage and exocrine enteric drainage. Rejections were biopsy-proved. Cytomegalovirus prophylaxis with gancyclovir was administered. The mean follow-up is 13 months (range, 1–30 months) for recipients of mean age 39 ± 7 years (17 men, 6 women). Mean cold ischemia time for kidney was 10.2 ± 3.9 hours, and for pancreas was 10.5 ± 3 hours. The rate of initial graft function was 100%. Graft rejection rate was 8%. The repeat laparotomy rate was 53% (12 patients), with a mean of 0.8 procedures per patient (range, 0 to 5). At the end of follow-up, patient survival was 95%, kidney survival was 85%, and pancreas survival was 83%. Patients with a functioning graft were insulin-free, with a mean fasting glucose concentration of 79 ± 7 mg/dL, hemoglobin A 1C of 4.5% (range, 4% to 4.9%) C-peptide of 5.9 ng/mL (range, 2.1 to 12 ng/mL), and a mean serum creatinine level of 1.6 mg/dL (range, 0.9 to 4.6 mg/dL). There was 1 death, due to posttransplantation lymphoproliferative disease confined to the pancreatic graft and abdominal sepsis at 3 months posttransplantation. Our results are similar to those of other series of SPK or PAK transplantations: low acute rejection rates, frequent requirement for repeat laparotomy, and good patient and graft survival, permitting an excellent quality of life.