Kidney transplantation together with another solid organ from the same donor--a single-center progress report

The aim of this study was to update our center's experience with combined renal transplants.

Between January 1987 and March 1997, 93 segmental pancreas and kidney transplants with bladder drainage and cyclosporine A-based immunosuppression were performed followed by another 40 combined pancreatoduodenal-renal transplants with enteric drainage and FK-based immunosuppression until December 1998. After a mean observation time of 87 and 13.6 months respectively, 1-year survival for patient, kidney and pancreas was 95%, 90% and 77% and 100%, 97.5% and 87.5%, respectively. Rejection and graft thrombosis were major causes of graft loss in the bladder drainage group and peripancreatitis in the enteric drainage group. From 23 December 1983, 20 patients received a combined liver-kidney transplant.

Main indications were glomerulonephritis and viral-induced cirrhosis. 5-year survival for patients and kidneys was 70% and for liver 62%. No rejections were identified in renal transplants, suggesting a potential immunoprotective effect of the liver. Septic complications were responsible for early death and disease recurrence for late patient loss.

From our experience with combined kidney transplants, we conclude that simultaneous transplantation of the pancreas does not adversely affect the outcome of renal transplantation and that after combined liver-kidney transplantation, the liver appears to immunologically protect the kidney.