[Morbidity and mortality of kidney and pancreas transplantation. Analysis of 810 transplantations at one center].
BACKGROUND
Simultaneous pancreas kidney transplantation (SPK) is well established in the treatment of patients with type 1 diabetes and end-stage renal disease, but despite improved surgical techniques morbidity is still high.


METHODS
A retrospective analysis of morbidity and mortality after first-time kidney transplantation (KTA: kidney transplant alone), pancreas transplantation (PTA: pancreas transplant alone), and SPK in a total of 810 patients was undertaken in our institution between January 1993 and December 2005.


RESULTS
Of the total of 810 patients who had first-time transplantations, 524 underwent KTA, 4 underwent PTA, and 282 underwent SPK. Morbidity and mortality was significantly higher in SPK than in KTA (p < 0.05). Risk of early postoperative loss of a transplant organ was higher in SPK than in KTA, and there were more re-operations in SPK than in KTA (p < 0.05). More patients had infections infections after SPK than after KTA (p < 0.001). There were 23.0 % wound infections in SPK and 11.8 % in KTA (p < 0.05). Organ rejection occurred in 18.1 % of the patients after SPK and in 13.4 % after KTA (p = 0.07). At the time of discharge 95.0 % of KTA patients did no longer need dialysis treatment, compared with 97.1 % of SPK patients, of whom 88 % became insulin independent. One-year organ survival rate was 88 % in KTA patients and 89 % (kidney) and 86 % (pancreas) in SPK patients.


CONCLUSIONS
Morbidity and mortality rates are still high after SPK. Excellent 1- and 5-year organ survival rates favor the use of SPK in type 1 diabetics associated with end-stage renal disease.
Schäffer
M
M
Chirurgische Universitätsklinik Bochum am Knappschaftskrankenhaus, Bochum-Langendreer, Deutschland. michael.schaeffer@kk-bochum.de
Wunsch
A
A
Michalski
S
S
Traska
T
T
Schenker
P
P
Viebahn
R
R
D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D007239:Infections / Q000453:epidemiology; D016030:Kidney Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D016035:Pancreas Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D016896:Treatment Outcome