Simultaneous kidney and pancreas transplantation at the San Raffaele Scientific Institute: clinical experience and results.
Pancreas and kidney transplantation is performed in uremic IDDM patients to cure end-stage renal failure and diabetes. Seventy-two simultaneous kidney-pancreas transplantations were performed at our Institution between July 1985 and November 1994. All transplants were performed using heart-beating cadaver donors. The first 25 patients received 26 segmental pancreas according to Dubernard (KPS), whereas the last 46 patients received a whole, bladder-drained pancrea according to Sollinger (KPW). Mean pancreas cold and warm ischemia times were 294 +/- 14 and 44 +/- 2 minutes, respectively, in the KPS group and 660 +/- 37 and 40 +/- 8 minutes, respectively, in the KPW group. Twelve (48%) KPS patients and 19 (41%) KPW patients had postoperative pancreas surgical complications: vascular thrombosis led to graft failure in 5 KPS patients (20%) and 2 KPW patients (4%) (p = 0.01). Pancreatic fistula, hemorrhagic complications, and duodenum-bladder leakage were the surgical complications observed more frequently. Six KPS patients (24%) and 8 KPW patients (17%) underwent reintervention as a consequence of surgical complications. Fifteen KPS patients (60%) and 30 KPW patients (65%) experienced an acute kidney rejection episode, which was steroid-resistant in 14 KPW and 2 KPS patients. The actuarial survival rates for simultaneous kidney-pancreas recipients at one and 4 years were 92% and 84%, respectively, for KPS recipients, and 95% and 88%, respectively, for KPW patients. Kidney actuarial survival rates at one and 4 years were 96% and 76% respectively, for group KPS, and 93% and 89%, respectively, for KPW patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Secchi
A
A
San Raffaele Scientific Institute, Milan, Italy.
Caldara
R
R
La Rocca
E
E
Martinenghi
S
S
Bernardi
M
M
Bonfatti
D
D
Caspani
L
L
Castoldi
R
R
Ferrari
G
G
Gallioli
G
G
D000206:Actuarial Analysis; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D003920:Diabetes Mellitus / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D007165:Immunosuppression Therapy; D017053:Infection Control; D007558:Italy / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D016035:Pancreas Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D018579:Patient Selection; D011182:Postoperative Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D012189:Retrospective Studies; D016019:Survival Analysis; D009927:Tissue and Organ Procurement; D016896:Treatment Outcome
D000925:Anticoagulants