[Simultaneous pancreas-kidney transplantation for the treatment of type I diabetes with end-stage renal disease].
OBJECTIVE
To demonstrate whether simultaneous pancreas-kidney transplantation is practical for the treatment of Type I diabetes with end-stage renal disease.


METHODS
Eight cases of combined pancreas-kidney transplantation were performed in our institute. The age ranged from 35 years to 48 years (average 43.46 years). All cases were diagnosed as type I diabetes with end-stage nephropathy, two cases with blindness due to retinopathy. The case history ranged from 2 years to 22 years. Pancreas allograft was placed in the right iliac fossa with pancreas exocrine drainage to bladder, whereas renal allograft the in left iliac fossa. Initial immunosuppression regimen is quadruple.


RESULTS
Seven patient could be insulin free after transplantation, with normal fasting blood glucose. One patient received insulin treatment for 40 days after operation. One patient survived 1 year and 9 months after transplantation with normal functioning pancreas allograft and kidney allograft. Four patient survived 2 months with normal allograft function. Fasting blood glucose was between 4.5 and 6.2 mmol/L; Cr was between 53 and 106 micromol/L. Diet control was not necessary. Two patient died of encephalorrhagia, and 1 pancreatic vascular thrombosis and necrotic pancreatitis.


CONCLUSIONS
Combined pancreas-kidney transplantation is feasible to treat type I diabetes with end-stage nephropathy. Functional pancreas allograft could be procured in the present condition. Pancreatic exocrine is drained to bladder. The diagnosis of acute rejection could be made earlier by detecting urine amylase. Heparin should be added in order to prevent pancreatic thrombosis.
He
B
B
Institute of Urology, Capital University of Medical Sciences, Beijing 100020, China.
Guan
D
D
Gao
J
J
Han
X
X
Liu
J
J
Han
Z
Z
Xu
J
J
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011183:Postoperative Complications / Q000517:prevention & control; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D000925:Anticoagulants; D007166:Immunosuppressive Agents; D006493:Heparin