title: [A case report of simultaneous liver, pancreas-duodenum, and kidney transplantation in a patient with post-hepatitic cirrhosis combined with uremia and insulin-dependent diabetes related to chronic pancreatitis].
abstract: OBJECTIVE
  To study the effect of triple organ transplantation (liver, kidney, and pancreas) in patient of end-stage liver disease with renal failure and diabetes, and to explore the optimal surgical procedure.
  
  
  METHODS
  Simultaneous piggyback orthotopic heterotopic liver, pancreas-duodenum, and kidney transplantation was performed on a 43-year-old male patient with exocrine pancreatic insufficiency and insulin-dependent diabetes related to chronic pancreatitis (CP) who developed hepatic and renal failure. The pancreatic exocrine secretions were drained enterically to the jejunum. Prednisone, tacrolimus, mycophenolate mofetil, and ATG were used as immunosuppression therapy.
  
  
  RESULTS
  Good liver and pancreas allograft function recovery was achieved within 7 days after the operation. And the recovery of renal allograft function was delayed. The renal allograft was removed because of break-down of renal blood flow 16 days after the transplantation. A new renal transplantation was performed at the same position. The second kidney graft recovered its normal function 3 days later. Up to the writing of this paper no acute rejection of organs and such complications as pancreatitis, thrombosis, and localized infection occurred. The patient became insulin independent with normal liver and renal function.
  
  
  CONCLUSIONS
  Simultaneous piggyback orthotopic heterotopic liver, pancreas-duodenum, and kidney transplantation can be a good method for the patients with exocrine pancreatic insufficiency and insulin-dependent diabetes combined with hepatic and renal failure.
authors.affiliation: Department of Urology, Xijing Hospital, Fourth Military University, Xi'an, China.
authors.forename: He
authors.initials: H
authors.lastname: Wang
authors.forename: Ke-feng
authors.initials: KF
authors.lastname: Dou
authors.forename: Xiao-jian
authors.initials: XJ
authors.lastname: Yang
authors.forename: Wei-jun
authors.initials: WJ
authors.lastname: Qin
authors.forename: Geng
authors.initials: G
authors.lastname: Zhang
authors.forename: Lei
authors.initials: L
authors.lastname: Yu
authors.forename: Fu-xia
authors.initials: FX
authors.lastname: Kang
authors.forename: Shao-yang
authors.initials: SY
authors.lastname: Chen
authors.forename: Li-ze
authors.initials: LZ
authors.lastname: Xiong
authors.forename: Zhen-shun
authors.initials: ZS
authors.lastname: Song
authors.forename: Zheng-cai
authors.initials: ZC
authors.lastname: Liu
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D004386:Duodenum / Q000637:transplantation; D006801:Humans; D016030:Kidney Transplantation; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D016377:Organ Transplantation; D016035:Pancreas Transplantation; D050500:Pancreatitis, Chronic / Q000150:complications*; D016896:Treatment Outcome; D014511:Uremia / Q000150:complications / Q000601:surgery*