title: Simultaneous pancreas-kidney transplantation: initial results from a center in Greece.
abstract: OBJECTIVE
  The outcome of simultaneous pancreas-kidney transplantation (SPK) in type 1 diabetes has dramatically improved in recent years. We report the initial results of our SPK program.
  
  
  METHODS
  From 2008 to 2010, we performed and prospectively obtained data on 4 SPKs in 4 type 1 diabetic patients with chronic renal failure. The recipients were 3 men and 1 woman, of overall mean age of 40.75 ± 4.78 years, mean time from diabetes diagnosis of 27 ± 15 years, and time on dialysis of 3.5 ± 0.57 years. All grafts were procured from multiorgan brain-dead donors of mean age 26 ± 8.16 years and mean body weight of 74 ± 4.34 kg. The pancreatic grafts were transplanted first into the right iliac fossa with mean cold ischemia times of 10.62 ± 3.09 hours for the pancreatic and 14.00 ± 2.97 hours for the renal grafts. Pancreas arterial inflow was re-established by an end-to-side anastomosis of an extension Y-graft to the recipient right iliac artery. The portal vein was sutured to the iliac vein directly. The exocrine secretions of the pancreas were managed by duodenojejunostomy extraperitoneally (n = 3) or intraperitoneally (n = 1). The ureteral anastomosis was performed using the Taguchi technique.
  
  
  RESULTS
  After SPK, endocrine pancreatic function was immediately restored in all patients. Insulin administration was stopped within the first 24 hours after surgery. Two patients displayed delayed renal graft function necessitating dialysis for 9 and 23 days, respectively. The postoperative course was prolonged with a mean hospital stay of 82 ± 1 day. At a 31.75 ± 9.03 months follow up all patients are alive with functioning grafts.
  
  
  CONCLUSIONS
  Our experience with SPK, although limited, has shown encouraging results over a short follow-up period.
authors.affiliation: Division of Transplantation, Department of Surgery, Aristotle University Medical School, Hippokration General Hospital, Thessaloniki, Greece. ifouzas@auth.gr
authors.forename: I
authors.initials: I
authors.lastname: Fouzas
authors.forename: N
authors.initials: N
authors.lastname: Antoniadis
authors.forename: D
authors.initials: D
authors.lastname: Giakoustidis
authors.forename: N
authors.initials: N
authors.lastname: Tatsou
authors.forename: E
authors.initials: E
authors.lastname: Mouloudi
authors.forename: A
authors.initials: A
authors.lastname: Karapanagiotou
authors.forename: A
authors.initials: A
authors.lastname: Sklavos
authors.forename: A
authors.initials: A
authors.lastname: Tsitlakidis
authors.forename: A
authors.initials: A
authors.lastname: Karakatsanis
authors.forename: G
authors.initials: G
authors.lastname: Myserlis
authors.forename: F
authors.initials: F
authors.lastname: Solonaki
authors.forename: M
authors.initials: M
authors.lastname: Daoudaki
authors.forename: A
authors.initials: A
authors.lastname: Petridis
authors.forename: A
authors.initials: A
authors.lastname: Papagiannis
authors.forename: D
authors.initials: D
authors.lastname: Gakis
authors.forename: G
authors.initials: G
authors.lastname: Imvrios
authors.forename: V
authors.initials: V
authors.lastname: Papanikolaou
mesh_terms: D000293:Adolescent; D000328:Adult; D051799:Delayed Graft Function / Q000209:etiology / Q000628:therapy; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006115:Greece; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000379:methods; D011446:Prospective Studies; D006435:Renal Dialysis; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin