Optimal timing for a pancreas transplant after a successful kidney transplant.
BACKGROUND
For certain uremic, diabetic patients, a sequential transplant of a kidney (usually from a living donor) followed by a cadaver pancreas has become an attractive option. But how long to wait after the kidney transplant before proceeding with a pancreas transplant is unclear. We studied outcomes in recipients of a pancreas at varying times after a kidney to determine the optimal timing for the second transplant.


METHODS
We compared pancreas after kidney (PAK) transplants performed early (< or =4 months) and late (>4 months) after the kidney transplant to determine any significant differences in surgical complications or outcomes between the two groups.


RESULTS
Between January 1, 1994, and September 30, 1998, we performed 123 cadaver PAK transplants. Of these, 25 (20%) were early and 98 (80%) were late. Characteristics of the two recipient groups were similar. We found no significant differences in outcome between the two groups. The incidence of surgical complications (bleeding, leaks, thrombosis, infections) and of opportunistic infections (such as cytomegalovirus) did not significantly differ between the two groups. Graft and patient survival rates were also equivalent (P=NS). The incidence of acute rejection by 3 months posttransplant was 20% in both groups.


CONCLUSIONS
The timing of the pancreas transplant for PAK recipients does not seem to influence outcome. As long as an acceptable organ is available and the recipient is clinically stable, a PAK transplant can be performed relatively soon after the kidney transplant.
Humar
A
A
Department of Surgery, University of Minnesota, Minneapolis 55455, USA.
Sutherland
D E
DE
Ramcharan
T
T
Gruessner
R W
RW
Gruessner
A C
AC
Kandaswamy
R
R
D000328:Adult; D002102:Cadaver; D003928:Diabetic Nephropathies / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D016030:Kidney Transplantation / Q000592:standards* / Q000706:statistics & numerical data; D019520:Living Donors; D016035:Pancreas Transplantation / Q000706:statistics & numerical data; D013997:Time Factors