title: A retrospective monocenter review of simultaneous pancreas-kidney transplantation with bladder drainage in China.
abstract: BACKGROUND
  Simultaneous pancreas-kidney transplantation (SPKT) frees the diabetic patient with end-stage nephropathy from dialysis and daily insulin injections. Herein, we review consecutive cases of SPKT with bladder drainage performed at our institution over an 8-year period.
  
  
  METHODS
  The study population included 21 patients (16 males and 5 females) who underwent SPKT between September 2001 and September 2009. Seven patients had type-1 diabetes and 14 had type-2 diabetes. Nineteen patients were on dialysis at the time of transplantation. Donation after cardiac death donors were selected for SPKT. The mean human leukocyte antigen match was 2 (range 0 - 4). SPKT was always performed using bladder drainage and vascular anastomoses to the systemic circulation. Immunosuppressive treatment consisted of anti-lymphocyte globulin induction followed by tacrolimus, mycophenolate mofetil, and prednisone.
  
  
  RESULTS
  The mean hospital stay was 45.43 days. After a mean follow-up of 39.4 months, survival rates for patient, kidney, and pancreas were 76.2%, 76.2%, and 66.7% at 1 year; 76.2%, 59.3%, and 55.6% at 5 years; and 57.1%, 39.5%, and 41.7% at 8 years, respectively. Major complications included anastomotic leaks, reflux pancreatitis, and rejection. Six patients died from septic shock (n = 3), duodenal stump leak (1), cardiac arrest (1), or renal failure (1). Eight kidney grafts were lost due to acute rejection (n = 2), chronic rejection (3), and death with a functioning graft (3). Pancreatic graft failure (9) was caused by thrombosis (n = 1), rejection (2), duodenal stump leak (1), and death with a functioning graft (5).
  
  
  CONCLUSIONS
  SPKT is a valid therapeutic option for uremic diabetics although few hospitals in China can undertake SPKT.
authors.affiliation: Department of Urology, Third Hospital of Peking University, Beijing 100191, China.
authors.forename: Hai
authors.initials: H
authors.lastname: Bi
authors.forename: Xiao-Fei
authors.initials: XF
authors.lastname: Hou
authors.forename: Lu-Lin
authors.initials: LL
authors.lastname: Ma
authors.forename: Kang-Ping
authors.initials: KP
authors.lastname: Luo
authors.forename: Guo-Liang
authors.initials: GL
authors.lastname: Wang
authors.forename: Lei
authors.initials: L
authors.lastname: Zhao
authors.forename: Ya-Li
authors.initials: YL
authors.lastname: Liu
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome; D014546:Urinary Catheterization
chemical_list: D007166:Immunosuppressive Agents