[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].
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.
Wang
He
H
Department of Urology, Xijing Hospital, Fourth Military University, Xi'an, China.
Dou
Ke-feng
KF
Yang
Xiao-jian
XJ
Qin
Wei-jun
WJ
Zhang
Geng
G
Yu
Lei
L
Kang
Fu-xia
FX
Chen
Shao-yang
SY
Xiong
Li-ze
LZ
Song
Zhen-shun
ZS
Liu
Zheng-cai
ZC
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*