Pancreas transplantation: whole gland
Simultaneous pancreas-kidney transplantation: short- and long-term results

https://doi.org/10.1016/j.transproceed.2004.02.041Get rights and content

Abstract

Simultaneous kidney and pancreas transplantation (SKPT) is the treatment of choice for a majority of type I diabetic patients with end-stage renal disease. With continual refinements in surgical technique and an evolving immunosuppressive arsenal, graft and patient survival have continually improved. The purpose of this study was to evaluate the short- and long-term results of SKPTs performed in 174 recipients from June 1985 to March 2003 including 37 segmental grafts with duct occlusion, 73 whole pancreas transplants with bladder diversion, and 64 whole pancreas grafts with enteric diversion. The series includes 160 cases with systemic drainage and 14 with portal drainage. In the segmental pancreas group, patient survival was 85%, 76%, and 53% with pancreas survival of 67%, 36%, and 15%, and kidney survival of 82%, 63%, and 15%, respectively, at 1, 5, and 10 years. Among the bladder diversion group, patient survival was 94%, 83%, and 73% pancreas survival 72%, 67%, and 65%, and kidney survival 89%, 78%, and 58%, respectively, 1, 5, and 10 years. Among the enter diversion group patient survival was 90% and 90% at 12 and 108 months, pancreas survival 80% and 65%, and kidney survival 85% and 85%, respectively. There were significant differences between curves of survival distribution according to the surgical technique applied for patients (P = .04), pancreas (P = .007), and kidney (P = .005). Based on the results from our study, the short- and long-term prognosis after SKPT is satisfactory, especially compared to the outcomes of long-term dialysis among patients with end-stage renal disease caused by type I diabetes.

Section snippets

Methods

All SKPT patients transplanted between June 1985 and March 2003 were evaluated for inclusion in this study. The patient characteristics are depicted in Table 1. Overall, the duct occlusion technique with segmental pancreas was employed in 37 cases; bladder diversion in 73; and enteric diversion in 64 patients. Pancreas procurement utilized standard technique. In the segmental pancreas category, the body and the tail of the gland were removed from the donor and neoprene was injected according to

Results

The causes of graft failure are depicted in Table 2. Patients, pancreas, and kidney median survival times were 144, 131, and 144 months, respectively. In the segmental pancreas group, patient survival was 85%, 76%, and 53%, pancreas survival 67%, 36%, and 15%, and kidney survival 82%, 63%, and 15%, respectively, at 1, 5, and 10 years. In the bladder diversion group, patient survival was 94%, 83%, and 73% pancreas survival 72%, 67%, and 65%, and kidney survival 89%, 78%, and 58%, respectively,

Discussion

Patients with diabetes mellitus with renal failure have a high mortality on dialysis therapy. In our study, short- and long-term survival patient and graft survival rates were satisfactory. These rates were comparable to the few long-term studies in the literature.2, 4, 5 Although the shortage of donor organs is the major factor limiting the number of pancreas transplantations performed worldwide, donor age of 40 years or older is related to a reduced pancreas graft survival. For these reasons,

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    Analyses of pancreas transplant outcomes for United States cases reported to the United Network Organ Sharing (UNOS) and non-US cases reported to The International Transplant Registry (IPTR)

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