Simultaneous pancreas-kidney transplantation: initial results from a center in Greece.

Abstract

AIM:

The outcome of simultaneous pancreas-kidney transplantation (SPK) in type 1 diabetes has dramatically improved in recent years. We report the initial results of our SPK program.

PATIENTS AND METHODS:

From 2008 to 2010, we performed and prospectively obtained data on 4 SPKs in 4 type 1 diabetic patients with chronic renal failure. The recipients were 3 men and 1 woman, of overall mean age of 40.75 ± 4.78 years, mean time from diabetes diagnosis of 27 ± 15 years, and time on dialysis of 3.5 ± 0.57 years. All grafts were procured from multiorgan brain-dead donors of mean age 26 ± 8.16 years and mean body weight of 74 ± 4.34 kg. The pancreatic grafts were transplanted first into the right iliac fossa with mean cold ischemia times of 10.62 ± 3.09 hours for the pancreatic and 14.00 ± 2.97 hours for the renal grafts. Pancreas arterial inflow was re-established by an end-to-side anastomosis of an extension Y-graft to the recipient right iliac artery. The portal vein was sutured to the iliac vein directly. The exocrine secretions of the pancreas were managed by duodenojejunostomy extraperitoneally (n = 3) or intraperitoneally (n = 1). The ureteral anastomosis was performed using the Taguchi technique.

RESULTS:

After SPK, endocrine pancreatic function was immediately restored in all patients. Insulin administration was stopped within the first 24 hours after surgery. Two patients displayed delayed renal graft function necessitating dialysis for 9 and 23 days, respectively. The postoperative course was prolonged with a mean hospital stay of 82 ± 1 day. At a 31.75 ± 9.03 months follow up all patients are alive with functioning grafts.

CONCLUSION:

Our experience with SPK, although limited, has shown encouraging results over a short follow-up period.

• Authors: I Fouzas, N Antoniadis, D Giakoustidis, N Tatsou, E Mouloudi, A Karapanagiotou, A Sklavos, A Tsitlakidis, A Karakatsanis, G Myserlis, F Solonaki, M Daoudaki, A Petridis, A Papagiannis, D Gakis, G Imvrios, V Papanikolaou
• Journal: Transplantation proceedings (Transplant Proc) Vol. 44 Issue 9 Pg. 2712-4 (Nov 2012) ISSN: 1873-2623 [Electronic] United States
• PMID: 23146501 (Publication Type: Journal Article)
• Copyright: Copyright © 2012 Elsevier Inc. All rights reserved.

Chemical References

• Hypoglycemic Agents
• Insulin

Topics

• Adolescent
• Adult
• Delayed Graft Function (etiology, therapy)
• Diabetes Mellitus, Type 1 (complications, surgery)
• Diabetic Nephropathies (etiology, surgery)
• Female
• Graft Survival
• Greece
• Humans
• Hypoglycemic Agents (therapeutic use)
• Insulin (therapeutic use)
• Kidney Failure, Chronic (etiology, surgery)
• Kidney Transplantation (adverse effects, methods)
• Length of Stay
• Male
• Middle Aged
• Multidetector Computed Tomography
• Pancreas Transplantation (adverse effects, methods)
• Prospective Studies
• Renal Dialysis
• Time Factors
• Treatment Outcome
• Young Adult