Simultaneous pancreas-kidney transplantation with modified enteric drainage of exocrine pancreatic secretion.
BACKGROUND
As a valid therapeutic option for patients with type 1 diabetes mellitus (IDDM) and secondary diabetic nephropathy, simultaneous pancreas-kidney transplantation (SPK) remains more undeveloped than other solid organ transplantations due to the restrictions of surgical techniques especially the modes of exocrine pancreatic secretion. The aim of this paper was to summarize our single-center experience in SPK with modified enteric drainage (ED).


METHODS
From June 2000 to July 2003, 10 patients with IDDM associated with uremia received SPK. The pancreatic allograft exocrine secretion was drained into the proximal jejunum via a side-to-side duodenojejunostomy without Roux-en-Y anastomosis. Quadruple immunosuppressive regimen consisted of induction of tacrolimus (TAC)/cyclosporine (CsA), mycophenolate mofetil (MMF), steroids and antibodies, which included antilymphocyte globulin (ALG) or anti-CD25 monoclonal antibody.


RESULTS
ED-SPK without Roux-en-Y anastomosis was successful in all 10 patients without serious complications such as pancreatitis, graft thrombosis and pancreatic fistula. The patients regained immediate kidney allograft function and euglycemia with insulin-independence. Four patients survived over one year. Episodes of acute rejection were observed in 4 patients, 3 of whom showed reversion after treatment of OKT3 or insulin. Early postoperative complications included peritoneal infection (2 patients), wound infection (2) and renal hematoma (1).


CONCLUSIONS
ED-SPK without Roux-en-Y anastomosis is safe and preferable to the patients with IDDM associated with uremia.
Liu
Bin
B
Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China. binliu@tjh.tjmu.edu.cn
Ming
Chang-Sheng
CS
Zeng
Fan-Jun
FJ
Sha
Bo
B
Chen
Zhi-Shui
ZS
Chen
Zhong-Hua
ZH
Chen
Shi
S
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D016896:Treatment Outcome; D014511:Uremia / Q000209:etiology / Q000601:surgery