Urological complications after simultaneous pancreas-kidney transplantation.
OBJECTIVE
We evaluated the incidence of urological complications after simultaneous renal and pancreatic transplantation.


METHODS
We retrospectively reviewed urological complications following 107 simultaneous kidney-pancreas transplantations performed at our institution between March 1995 and June 2008. The 46 women and 61 men were of mean age 37.8 years (range, 25-66). The mean duration of diabetes mellitus was 23.0 years (range, 9-48) and the mean duration of dialysis was 19.9 months (range, 0-70). The exocrine pancreatic secretions were drained to bladder in 58 cases, or enterically in 49 patients. The mean length of follow-up was 51.7 months.


RESULTS
The most frequent urological complication was urinary tract infection, reported in 63.8% of patients: 42 bladder-drained and 25 enteric-drained (P = .011). Hematuria occurred in 13 patients (12.5%): 12 bladder-drained and 1 enteric-drained (P = .002). Five bladder-drained patients developed bladder calculi. Among 58 bladder-drained patients, reflux pancreatitis occurred in 28 patients and urine leaks related to the pancreatic graft occurred in 7 patients. Conversion of exocrine secretions from bladder to enteric diversion was required in 6 patients. One- and 3-year patient survival rates were 92.7% and 89.1%, respectively. Moreover, 1 and 3-year kidney graft survival rates were 90.6% and 84.4%, and pancreas graft survival rates were 78.1 and 70.3%, respectively.


CONCLUSIONS
Simultaneous kidney-pancreas transplantation with bladder drainage is associated with a high frequency of urological complications. Appropriate treatment can resolve most complications. In our opinion, both enteric and bladder drainage seemed to be safe and effective alternatives to manage pancreatic exocrine secretions.
Medina Polo
J
J
Department of Urology, Hospital Universitario 12 de Octubre, Madrid, Spain. josemedinapolo@telefonica.net
Morales
J M
JM
Blanco
M
M
Aguirre
J F
JF
Andrés
A
A
Díaz
R
R
Jiménez
C
C
Leiva
O
O
Meneu
J C
JC
Moreno
E
E
Pamplona
M
M
Passas
J
J
Rodríguez
A
A
de la Rosa
F
F
D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000601:surgery; D003928:Diabetic Nephropathies / Q000601:surgery / Q000628:therapy; D004322:Drainage / Q000009:adverse effects / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006417:Hematuria / Q000453:epidemiology; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods; D017582:Renal Replacement Therapy; D012189:Retrospective Studies; D014552:Urinary Tract Infections / Q000453:epidemiology*; D014570:Urologic Diseases / Q000453:epidemiology*