title: Combined pancreas and en bloc kidney transplantation using a bladder patch technique from very small pediatric donors.
abstract: Very small pediatric donors are underutilized for pancreas and kidney transplantation for the fear of inadequate islet mass and higher incidence of technical complications, and the lower age limit for such donors is not well defined. We present here two cases of combined pancreas and en bloc kidney transplantation from very small pediatric donors (14 and 18 months old) to adult type 1 diabetic and uremic patients. The conventional surgical procedure for simultaneous pancreas and kidney transplantation with systemic venous and bladder exocrine drainage was successfully applied to very small organs. For both, we utilized the recently described bladder patch technique for ureteral reconstruction. One patient developed venous thrombosis (partial thrombosis of the splenic and mesenteric veins) and the other urine leak (from a midportion of the medial ureter without compromising the bladder patch) after the transplants; both were successfully managed and the patients demonstrated immediate and sustained pancreas and kidney graft functions for 12 and 2 months posttransplantation. These cases illustrate the feasibility of combined pancreas and en bloc kidney transplantation from very small pediatric donors using a bladder patch technique to avoid small ureteral anastomosis.
authors.affiliation: The DeWitt Daughtry Family Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, FL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Sageshima
authors.forename: G
authors.initials: G
authors.lastname: Ciancio
authors.forename: L
authors.initials: L
authors.lastname: Chen
authors.forename: G
authors.initials: G
authors.lastname: Selvaggi
authors.forename: S
authors.initials: S
authors.lastname: Nishida
authors.forename: E
authors.initials: E
authors.lastname: Akpinar
authors.forename: E
authors.initials: E
authors.lastname: Nesher
authors.forename: A
authors.initials: A
authors.lastname: Romano
authors.forename: R
authors.initials: R
authors.lastname: Misawa
authors.forename: G W
authors.initials: GW
authors.lastname: Burke
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D004322:Drainage; D005240:Feasibility Studies; D006801:Humans; D007223:Infant; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D008642:Mesenteric Veins; D009929:Organ Size; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods*; D013162:Splenic Vein; D014019:Tissue Donors; D016896:Treatment Outcome; D014511:Uremia / Q000601:surgery*; D001743:Urinary Bladder / Q000637:transplantation*; D014549:Urinary Incontinence / Q000209:etiology / Q000628:therapy; D020246:Venous Thrombosis / Q000209:etiology / Q000628:therapy