title: Simultaneous pancreas and kidney transplantation: a feasible procedure in selected patients.
abstract: We analyzed the overall results of 24 simultaneous pancreas and kidney transplantations (SPK), performed in our hospital between April 1986 and June 1990. All patients had type I diabetes mellitus and end-stage renal failure. We used bladder drainage of the pancreatic exocrine secretions through a duodenocystostomy. The blood vessels of both grafts were anastomosed to the iliac vessels. The immunosuppressive management was triple-therapy with cyclosporin, azathioprine and prednisone. All organs were transplanted without matching donors and recipients for HLA. At the time of transplantation, mean recipient age was 37 yr; the average duration of diabetes was 22 yr. After disappointing results in the first 4 patients, the pancreas was placed intraperitoneally instead of extraperitoneally and the antibiotic drug regimen was altered. In the second group (n = 20), patient survival was 100%; 1-yr pancreas and kidney graft survival were 65 and 62%, respectively. Duration of hospitalization and pancreas and kidney graft loss were positively correlated with the number of rejection episodes. After 1 yr of follow-up, the mean creatinine clearance was 62 ml/min and the mean HbA1c was 5.5%. Blood glucose levels and oral glucose tolerance tests were also normal. We conclude that patient and graft survival after SPK are satisfactory, although rejection-related morbidity is still a major problem.
authors.affiliation: Department of Nephrology, Leiden University Hospital, Netherlands.
authors.forename: E C
authors.initials: EC
authors.lastname: van Oosterhout
authors.forename: F J
authors.initials: FJ
authors.lastname: van der Woude
authors.forename: H H
authors.initials: HH
authors.lastname: Lemkes
authors.forename: H G
authors.initials: HG
authors.lastname: Gooszen
authors.forename: H
authors.initials: H
authors.lastname: van Bronswijk
authors.forename: P J
authors.initials: PJ
authors.lastname: van den Akker
authors.forename: J T
authors.initials: JT
authors.lastname: Tamsma
authors.forename: J L
authors.initials: JL
authors.lastname: Terpstra
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006789:Host vs Graft Reaction; D006801:Humans; D007165:Immunosuppression Therapy; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D016896:Treatment Outcome