Simultaneous pancreas-kidney transplantation: is the failure of the grafts also simultaneous?
BACKGROUND
It is well known that after a simultaneous pancreas and kidney transplantation (SPKT) there is a higher incidence of pancreatic graft loss in the acute period, due to technical problems. However, there is little information about the survival of pancreatic and kidney grafts 1 year after transplantation.


OBJECTIVE
To analyze the causes of long-term graft loss of SPKT in our hospital and to determine if this loss occurs simultaneously or is isolated.


METHODS
We analyzed the data of 63 SPKTs performed between February 1983 and October 2005, including the cases with normal renal and pancreatic function after 1 year of transplantation, and with a loss of one or two organs during the follow-up period (8 +/- 4 years). We defined simultaneous SPKT failure as failure that occurs at the same time or when the period between pancreatic and renal graft failure is shorter than 9 months.


RESULTS
In 28 patients (44%), there was a simultaneous graft failure, whereas in 35 (56%) the loss of function occurred in only one organ or in both, but separately. Death was responsible for 75% (21/28) of simultaneous graft losses, representing 25% (9/35) of isolated graft failures. Cardiovascular disease was the leading cause of death. In 14 of 35 isolated graft failures, there was loss of renal and pancreatic function (11/14 kidney failed first) with a 2.9 +/- 2.3 years of interval. In 12 cases there was only loss of pancreatic function, whereas in nine cases the affected organ was the kidney. Graft chronic nephropathy and chronic rejection in the pancreas were the main causes of graft failure.


CONCLUSIONS
The main cause of simultaneous SPKT failure is patient death; however, among isolated or separated SPKT failures, the kidney failed first, more frequently.
Nicolau
J
J
Hospital Clínic, Barcelona, Spain.
Ricart
M J
MJ
Astudillo
E
E
Esmatjes
E
E
Oppenheimer
F
F
Fernández-Cruz
L
L
D000328:Adult; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013030:Spain; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome