title: Successful Combined Pancreas Fourth-Kidney Third and Pancreas Third-Kidney Second Transplantation: A Case Report.
abstract: Extremely few reports have been published on experience with multiple combined pancreas-kidney re-transplantation including long-term results. We here analyze our experience with two patients following successful combined pancreas fourth-kidney third and pancreas third-kidney second transplantation.
  
  
  METHODS
  Patient and graft survival as well as graft function and major complications were recorded. Patient 1 (women, 47 years) underwent combined pancreas fourth-kidney third transplantation after previous removal of the first and second renal and the second pancreatic grafts. Patient 2 (men, 51 years) underwent combined pancreas third-kidney second transplantation after nephrectomy of the first renal graft. Immunosuppression consisted of induction with alemtuzumab and maintenance with tacrolimus, mycophenolate mofetil/mycophenolic acid and steroids.
  
  
  RESULTS
  After a follow-up of 44 and 49 months, respectively, both patients are doing well with stable graft function. Leukopenia, thrombocytopenia, bacterial sepsis, and chronic hepatitis C as major complications were controllable.
  
  
  CONCLUSIONS
  Multiple pancreas-retransplantations combined with simultaneous renal transplantation are feasible. Meticulous immunosuppression, careful monitoring, and excellent patient adherence are of crucial importance.
authors: Department of Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors: Claudia
authors: C
authors: Bösmüller
authors: Department of Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors: Manuel
authors: M
authors: Maglione
authors: Department of Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors: Christian
authors: C
authors: Margreiter
authors: Department of General Surgery, Charité Virchow Hospital, Berlin, Germany.
authors: Tomasz
authors: T
authors: Dziodzio
authors: Department of General Surgery, Charité Virchow Hospital, Berlin, Germany.
authors: Matthias
authors: M
authors: Biebl
authors: Department of General Surgery, Charité Virchow Hospital, Berlin, Germany.
authors: Johann
authors: J
authors: Pratschke
authors: Department of General Surgery, Charité Virchow Hospital, Berlin, Germany.
authors: Robert
authors: R
authors: Öllinger
authors: Department of Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors: Dietmar
authors: D
authors: Öfner
authors: Department of Transplant Surgery, Medical University of Innsbruck, Innsbruck, Austria.
authors: Stefan
authors: S
authors: Schneeberger