title: Simultaneous pancreas-kidney transplantation: five-year results from a single center.
abstract: We report the 5-year results of our simultaneous pancreas-kidney transplantation (SPKT) program, started on May 2, 2000. Forty-two SPKT were performed on 42 type I diabetic patients with chronic renal failure. The procedure was performed with enteric diversion and vascular anastomosis to the iliac vessels. Immunosuppressive protocol included antithymocyte globulin, tacrolimus, mycophenolate mofetil, and steroids. The 24 women and 18 men had a mean age of 33.5 +/- 6.3 years and mean 22.8 +/- 14.2 years time of diabetes evolution. Forty patients had been on dialysis for 34.3 +/- 24.1 months, and two were preemptive transplantations. Acute rejection episodes were treated in eight patients (19.1%): in three cases they affected both organs; in two only the kidney was affected; and the other three were pancreas graft rejections. The incidence of postoperative complications requiring re-operation was 42.9%, mostly pancreas graft related. Two patients died, one due to cardiovascular disease; the other was transplant related. Three kidney grafts were lost, and the causes were immunologic, thrombosis, and patient death. Pancreas graft loss occurred in seven patients: thrombosis (n = 3); infection (n = 3); immunologic (n = 1). The patients with surviving grafts were doing well, with normal kidney and pancreas function: serum creatinine = 0.89 +/- 0.15 mg/dL; fasting blood glucose = 79 +/- 16 mg/dL; HbA1c = 4.7 +/- 1.1%. The 1-year patient, kidney, and pancreas survival rates were 97.3%, 94.6%, and 83.8% and 5-year values, 91.7%, 89.2%, and 78.7%, respectively. In conclusion, these results are similar to the most recent UNOS/IPTR reports, leading us to consider our experience with SPKT very positive.
authors.affiliation: Nephrology Department, Hospital Santo António, Largo Professor Abel Salazar, 4050-011 Porto, Portugal. lasalete@clix.pt
authors.forename: L
authors.initials: L
authors.lastname: Martins
authors.forename: S
authors.initials: S
authors.lastname: Pedroso
authors.forename: A C
authors.initials: AC
authors.lastname: Henriques
authors.forename: L
authors.initials: L
authors.lastname: Dias
authors.forename: A M
authors.initials: AM
authors.lastname: Sarmento
authors.forename: R
authors.initials: R
authors.lastname: Seca
authors.forename: F
authors.initials: F
authors.lastname: Oliveira
authors.forename: J
authors.initials: J
authors.lastname: Dores
authors.forename: A
authors.initials: A
authors.lastname: Lhamas
authors.forename: T
authors.initials: T
authors.lastname: Coelho
authors.forename: A
authors.initials: A
authors.lastname: Ribeiro
authors.forename: S
authors.initials: S
authors.lastname: Esteves
authors.forename: R
authors.initials: R
authors.lastname: Pereira
authors.forename: R
authors.initials: R
authors.lastname: Almeida
authors.forename: M
authors.initials: M
authors.lastname: Amil
authors.forename: A
authors.initials: A
authors.lastname: Cabrita
authors.forename: M
authors.initials: M
authors.lastname: Teixeira
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery; D005260:Female; D006084:Graft Rejection / Q000453:epidemiology; D006085:Graft Survival / Q000502:physiology*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors
chemical_list: D007166:Immunosuppressive Agents