title: Ten years of simultaneous pancreas-kidney transplantation: a retrospective single-center analysis of prospectively obtained data.
abstract: BACKGROUND
  Simultaneous pancreas-kidney transplantation (SPK) is a standardized and life-saving procedure for a patient suffering from both insulin-dependent diabetes mellitus type 1 (IDDM 1) and end-stage diabetic nephropathy. To expand the donor pool and to determine the influence of the preprocurement pancreas suitability scoring system (P-PASS) on pancreas graft survival we retrospectively analyzed our data on SPK.
  
  
  METHODS
  From 1999 to 2010 we performed 55 SPKs, using systemic-enteric drainage as surgical approach. The immunosuppressive therapy was induced with basiliximab; maintenance therapy was based on tacrolimus, mycophenolate mofetil, and steroids. Data were prospectively obtained, analyzed, and correlated to the P-PASS.
  
  
  RESULTS
  The overall 10-year patient survival rate was 78% with a 10-year pancreas survival rate of 53%. Three patients needed retransplantation of SPK and 6 patients needed singular pancreas retransplantation. Seventeen patients showed acute rejection episodes and 14 patients suffered from cytomegalovirus (CMV) infections. We compared 43 patients receiving organs from an "ideal" donor (P-PASS <17) with 12 patients receiving grafts from "marginal" donors (P-PASS ≥17). Neither P-PASS nor donor age demonstrated significant influence on pancreas graft survival. However, the body mass index (BMI) of the donor showed a negative tendency (P = .059).
  
  
  CONCLUSIONS
  The P-PASS showed no significant prediction of pancreas graft survival. In view of our data, expansion of the German donor pool is possible. A multicenter study of SPK using "marginal" pancreas grafts is mandatory to define a realistic "cut-off" value for P-PASS.
authors.affiliation: Department of Transplant Surgery, University Medical Center, Johannes Gutenberg University, Mainz, Germany. daniel.foltys@unimedizin-mainz.de
authors.forename: D B
authors.initials: DB
authors.lastname: Foltys
authors.forename: J M
authors.initials: JM
authors.lastname: Kaths
authors.forename: T
authors.initials: T
authors.lastname: Zimmermann
authors.forename: M
authors.initials: M
authors.lastname: Heise
authors.forename: M
authors.initials: M
authors.lastname: Hoppe-Lotichius
authors.forename: G
authors.initials: G
authors.lastname: Otto
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002470:Cell Survival; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D003928:Diabetic Nephropathies / Q000628:therapy*; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents