Simultaneous pancreas-kidney transplantation at the Ohio State University Medical Center

Simultaneous pancreas-kidney transplantation is becoming an accepted procedure for the treatment of Type I diabetic patients with end-stage renal disease. Its value in Type II diabetic patient remains to be evaluated. With the improvements in technical skills and immunosuppression medications, the procedure has become safer than those performed in the previous decade. However, the diabetic host is a high-risk individual. Careful evaluation and selection is prudent to keep excellent results with this scarce organ. As we have seen in this series, death is the number one cause of graft loss and better preoperative evaluation will continue to be of significant value to lower the mortality rate of SPK transplantation. We are moving to the use of marginal donors and marginal recipients very carefully and more data is needed to prove its safety and cost effectiveness. At our center, long-term patient and graft survival have been acceptable (86% and 73%, respectively, at 5 years). We will continue to use SPK transplantation as the procedure of choice for excellent candidates. We may need to change our philosophy to use living-related kidney transplants followed by a sequential pancreas transplant to overcome some of the shortage of pancreatic organs. The issue of primary enteric drainage has not been addressed in this report due to our success with bladder drainage. Despite the lower threshold for enteric conversion, about 10% of our patients are converted.