title: Simultaneous pancreas and kidney transplantation for liver transplant recipients with diabetes and uremia.
abstract: OBJECTIVE
  Chronic kidney disease (CKD) has become a critical problem due to immunosuppressant related nephrotoxicity in liver transplant (LTx) recipients, especially in patients with pre-transplant risk factors. LTx recipients with uraemia and diabetes have poor prognosis even when treated with dialysis and insulin. Simultaneous pancreas and kidney transplantation (SPK) has been proven to be an effective treatment for patients with diabetic uraemia, but rarely performed in patients after LTx. Two cases of SPK after LTx were performed in our centre and we present our experience here.
  
  
  METHODS
  Two patients received LTx because of HBV related liver cirrhosis; both of them had pre-transplant diabetes mellitus (DM), which worsened after the administration of immunosuppressive drugs. These two patients suffered from CKD and developed uraemia due to diabetic nephropathy and immunosuppressive drugs induced renal toxicity years after LTx. They relied on dialysis and insulin injection. SPK were performed years after LTx and the clinical data was retrospectively analyzed.
  
  
  RESULTS
  SPK was successfully performed in these two patients. Pancreatic fluid drainage was achieved via a side-to-side duodenojejunostomy into the proximal jejunum. No serious surgical complications, including pancreatitis or pancreatic fistula were observed postoperatively. In both cases, kidney and pancreatic grafts were functioning well as evidenced by euglycemia without the need for insulin injections and normal serum-creatinine level 7days after the operation. One of the patients presented with renal graft impairment 1week after the operation. FK506 was tapered and rapamycin was used when the renal graft biopsy indicated drug toxicity. The patient's kidney graft function recovered gradually after the adjustment. Both patients have good function of liver, kidney and pancreas grafts during a 60-month and 30-month period of follow up.
  
  
  CONCLUSIONS
  SPK could serve as an effective option for patients with diabetes and uremia after LTx. Perioperative management, especially the immunosuppressive strategy is crucial to improve the outcome of this procedure.
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China; Hepatobiliary surgery department, the University of Hong Kong, Shenzhen Hospital, Shenzhen, Guangdong, China.
authors.forename: Ngalei
authors.initials: N
authors.lastname: Tam
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Chuanzhao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Jianwei
authors.initials: J
authors.lastname: Lin
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Chenglin
authors.initials: C
authors.lastname: Wu
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Ronghai
authors.initials: R
authors.lastname: Deng
authors.affiliation: Pathology Department, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Bing
authors.initials: B
authors.lastname: Liao
authors.affiliation: Department of Clinical Laboratories, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China.
authors.forename: Shuiqing
authors.initials: S
authors.lastname: Hu
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Dongping
authors.initials: D
authors.lastname: Wang
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
authors.forename: Xiaofeng
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address: lw97002@163.com.
authors.forename: Linwei
authors.initials: L
authors.lastname: Wu
authors.affiliation: Organ Transplantation Center of the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China. Electronic address: gdtrc@163.com.
authors.forename: Xiaoshun
authors.initials: X
authors.lastname: He
mesh_terms: D003920:Diabetes Mellitus / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000150:complications / Q000601:surgery*; D006801:Humans; D016030:Kidney Transplantation; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D014511:Uremia / Q000601:surgery*