title: Surgical complications are the main cause of pancreatic allograft loss in pancreas-kidney transplant recipients.
abstract: We examined surgical complications among a group of diabetic type 1 patients (IDDM) with end-stage renal disease (ESRD) who had undergone pancreas-kidney transplantations (PK). Between October 1993 and August 2004, 70 SPK were performed using bladder (n = 14) or enteric (n = 56) drainage. Donors were selected according to standard criteria (mean age, 27.6 years; range, 17-49). All patients received cyclosporine-based immunosuppression. All pancreata functioned immediately, whereas 2 patients needed postoperative dialysis. Four patients (5.7%) lost their pancreatic graft due to vascular thrombosis; both patients underwent urgent allograft pancreaectomy and pancreas retransplantation (re-PT). One of them (1.4%) experienced a venous thrombosis and died due to a pulmonary embolism at 12 hours after re-PT. The other 3 patients had uneventful postoperative courses and were discharged with good pancreatic and renal function. Three patients in the bladder group (21.4%) had an anastomotic leak, which resolved with a bladder catheter. Four patients in the enteric group (7.1%) who experienced an anastomotic leak needed a second surgical procedure but in 3 of them allograft pancreatectomy was necessary. Relaparotomy was required in the other 3 patients due to hemorrhage (1 patient) or occlusion (2 patients). Acute rejection episodes, which occurred in 16 patients (22.8%), were treated with steroid boluses. With a mean follow-up of 72 months (range, 3-129), 2 patients have died at 8 and at 36 months, respectively, after SPK due to acute myocardial infarction (2.9%). Chronic rejection was the leading cause of pancreatic failure in 5 patients (7.1%) and of renal failure in 2 patients (2.8%). Patient, kidney, and pancreas survival rates were 95.8%, 92.9%, and 81.5%, respectively. Surgical complications were the leading cause of pancreatic allograft loss in IDDM and ESRD patients submitted to SPK.
authors.affiliation: Kidney and Pancreas Transplantation Unit, Niguarda Hospital, Milan, Italy.
authors.forename: C V
authors.initials: CV
authors.lastname: Sansalone
authors.forename: G
authors.initials: G
authors.lastname: Maione
authors.forename: P
authors.initials: P
authors.lastname: Aseni
authors.forename: I
authors.initials: I
authors.lastname: Mangoni
authors.forename: A
authors.initials: A
authors.lastname: De Roberto
authors.forename: S
authors.initials: S
authors.lastname: Soldano
authors.forename: E
authors.initials: E
authors.lastname: Minetti
authors.forename: M L
authors.initials: ML
authors.lastname: Broggi
authors.forename: G
authors.initials: G
authors.lastname: Civati
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery*; D004322:Drainage / Q000379:methods; D005260:Female; D006085:Graft Survival; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality / Q000502:physiology*; D018579:Patient Selection; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D017211:Treatment Failure; D001743:Urinary Bladder / Q000601:surgery