title: Simultaneous pancreas-kidney transplant from living related donor: a single-center experience.
abstract: BACKGROUND
  Simultaneous pancreas and kidney transplantation (SPK) from cadaveric donors has become a widely accepted therapeutic option for insulin-dependent uremic patients. In 1996 the first SPK from a live donor was performed. This procedure offers the advantage of a better immunologic match, reduced cold ischemia injury, and decreased waiting time. As such, it is an attractive alternative treatment for diabetic patients with end-stage nephropathy with an available living donor.
  
  
  METHODS
  We performed six SPKs from living-related donors. There were four men and two women among the recipients; median age was 34 (range, 29-39) years. All donors were recipients' siblings with excellent HLA matching. Donors underwent standardized metabolic workup, anti-insulin and anti-islet antibody assays, and computed tomography of the abdomen. Both donors and recipients were treated with octreotide for 5 days perioperatively. After transplantation, the patients were maintained on tacrolimus-based immunosuppression, with the exception of one recipient of SPK from an identical twin, who received cyclosporine monotherapy.
  
  
  RESULTS
  All the donors are doing well and have normal renal function and blood glucose levels. One-year patient, renal, and pancreatic graft survival rates were 100%, 100%, and 83%, respectively. Acute kidney rejection was documented in two patients, and both recovered completely after OKT3 therapy. No rejection of pancreatic graft has been documented. Except for one patient who lost the graft because of hemorrhagic pancreatitis, all recipients maintained serum glucose levels at less than 130 mg/dL without insulin therapy. No major surgical complications such as graft thrombosis, intra-abdominal infection, or abscess were reported.
  
  
  CONCLUSIONS
  Living donor SPK can represent a successful alternative to cadaveric donor SPK. The procedure can be performed safely in the donor and with low morbidity in the recipient.
authors.affiliation: Department of Surgery, University of Illinois at Chicago, Chicago, IL 60612, USA.
authors.forename: Adam
authors.initials: A
authors.lastname: Zieliński
authors.forename: Sławomir
authors.initials: S
authors.lastname: Nazarewski
authors.forename: Diego
authors.initials: D
authors.lastname: Bogetti
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sileri
authors.forename: Giuliano
authors.initials: G
authors.lastname: Testa
authors.forename: Howard
authors.initials: H
authors.lastname: Sankary
authors.forename: Enrico
authors.initials: E
authors.lastname: Benedetti
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D002102:Cadaver; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D016853:Muromonab-CD3 / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000379:methods*; D016559:Tacrolimus / Q000627:therapeutic use; D014019:Tissue Donors; D016896:Treatment Outcome; D014511:Uremia / Q000209:etiology / Q000601:surgery
chemical_list: D001786:Blood Glucose; D007166:Immunosuppressive Agents; D016853:Muromonab-CD3; D016559:Tacrolimus