Simultaneous pancreas and kidney composite graft transplantation with retroperitoneal systemic-enteric drainage.
BACKGROUND
Simultaneous pancreas and kidney transplantation is the treatment of choice for diabetes mellitus patients with associated end-stage renal disease. Limited vascular access could be encountered in patients with severe atherosclerosis, and/or severe obesity and in re-transplant patients. We describe a modified technique that facilitates simultaneous pancreas and kidney (SPK) composite graft transplantation with retroperitoneal systemic-enteric drainage for patients with limited vascular access.


METHODS
Since April 2012, we performed a modified technique for 2 patients with limited vascular access. SPK composite graft was constructed during the back-table preparation and transplanted in the right retroperitoneal space, finally covered by the ascending colon and its mesocolon.


RESULTS
The 2 patients achieved good pancreas grafts function with normal blood glucose immediately after the completion of reperfusion. Their kidney grafts have also shown good function. They have not had any rejection episodes or postoperative complications after the SPK composite graft transplantation.


CONCLUSIONS
We propose that simultaneous pancreas and kidney composite graft transplantation with retroperitoneal systemic-enteric drainage can be a viable option for patients with limited vascular access.
Departments of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan.
Shinichiro
S
Ono
Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan.
Tamotsu
T
Kuroki
Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan.
Amane
A
Kitazato
Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan.
Tomohiko
T
Adachi
Departments of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
Yin-Yin
YY
Chen
Departments of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
Shin-Chin
SC
Chen
Department of Surgery, Nagasaki University, Graduate School of Biomedical Sciences, Nagasaki, Japan.
Susumu
S
Eguchi
Department of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
Yi-Ming
YM
Shyr
Departments of Surgery, Taipei Veterans General Hospital, National Yang Ming University, Taipei, Taiwan.
Shin-E
SE
Wang
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000601:surgery*; D004322:Drainage / Q000379:methods*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods*; D016896:Treatment Outcome