Kidney-pancreas transplants: is it so difficult to start a program?

Area of Science:

• Nephrology
• Endocrinology
• Transplant Surgery

Background:

• Simultaneous kidney-pancreas (SKP) and pancreas after kidney (PAK) transplantation are primary treatments for type 1 diabetes mellitus with end-stage renal failure.
• Concerns regarding serious intraabdominal complications in immunosuppressed patients can hinder program initiation.

Purpose of the Study:

• To review the initial experience and outcomes of SKP and PAK transplantations.
• To assess the feasibility and safety of establishing a kidney-pancreas transplant program.

Main Methods:

• Twenty-three patients (20 SKP, 3 PAK) with type 1 diabetes mellitus underwent transplantation between June 2000 and October 2003.
• Immunosuppression included thymoglobulin, prednisone, tacrolimus, and mycophenolate mofetil.
• Procedures involved portal venous drainage, exocrine enteric drainage, and cytomegalovirus prophylaxis with ganciclovir.

Main Results:

• The mean follow-up was 13 months, with 100% initial graft function and an 8% acute rejection rate.
• Patient survival was 95%, kidney survival 85%, and pancreas survival 83%.
• Repeat laparotomy was required in 53% of patients; functioning graft recipients were insulin-free with improved glycemic control and serum creatinine levels.

Conclusions:

• SKP and PAK transplantations demonstrate outcomes comparable to other series, including low acute rejection rates and good patient/graft survival.
• Frequent repeat laparotomies are noted, but overall results permit an excellent quality of life for recipients.
• The study supports the viability of kidney-pancreas transplantation programs despite potential complications.