title: One hundred eleven simultaneous pancreas-kidney transplantations: 10-year experience from a single center in Portugal.
abstract: From May 2000 to May 2010, we performed 111 simultaneous pancreas-kidney transplants (SPKT) from cadaveric donors, by using enteric drainage and systemic vascular anastomosis. In 26 cases they showed 6 HLA mismatches. Immunosuppression included antithymocyte globulin, tacrolimus, mycophenolate mofetil, and steroids. The patients' mean age was 34 ± 6 years, and mean time from diabetes diagnosis was 23 ± 6 years; 107 patients had been on dialysis for 32 ± 24 months, and 4 had a preemptive status. Acute rejection episodes were detected in 20 patients (18%): in 3 cases they affected both organs, in 9 only the kidney, and in 8 only the pancreas. The incidence of complications needing reoperation was 28.8%. They were mostly pancreas graft-related, including bleeding, thrombosis, and infection. In more recent years, after a slight modification of surgical technique, we noted a decreased rate of complications. Six patients died from: 2 from cardiovascular or cerebrovascular disease, 3 from infection, and 1 from an unknown cause. Pancreas graft loss occurred in 26 and kidney graft loss in 12 patients. Four patients underwent a second pancreas and 5 a second kidney graft. Patients with surviving grafts showed good function: serum creatinine, 1.09 ± 0.23 mg/dL; fasting blood glucose, 79.7 ± 9.8 mg/dL; and HbA(1c), 4.88 ± 0.47%. Patient, kidney, and pancreas survival results were 96%, 96%, and 83% at 1; 94%, 91%, and 75% at 5; and 94%, 62%, and 69% at 10 years, respectively. These good results, compared with larger series and to recent pancreas transplant registry reports, are a strong motivation for the further development of this unique program in Portugal.
authors.affiliation: Nephrology Department, Hospital Santo António, Porto, Portugal. lasalete@clix.pt
authors.forename: L
authors.initials: L
authors.lastname: Martins
authors.forename: A C
authors.initials: AC
authors.lastname: Henriques
authors.forename: L
authors.initials: L
authors.lastname: Dias
authors.forename: S
authors.initials: S
authors.lastname: Pedroso
authors.forename: M
authors.initials: M
authors.lastname: Almeida
authors.forename: J
authors.initials: J
authors.lastname: Santos
authors.forename: J
authors.initials: J
authors.lastname: Dores
authors.forename: R
authors.initials: R
authors.lastname: Almeida
authors.forename: A
authors.initials: A
authors.lastname: Cabrita
authors.forename: M
authors.initials: M
authors.lastname: Teixeira
mesh_terms: D000293:Adolescent; D000328:Adult; D002102:Cadaver; D005260:Female; D006084:Graft Rejection; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation; D011174:Portugal
chemical_list: D007166:Immunosuppressive Agents