[Pancreatic transplantation: success and problems].

Area of Science:

• Nephrology
• Transplantation Surgery
• Endocrinology

Background:

• Pancreatic transplantation outcomes have improved with bladder drainage.
• Simultaneous kidney transplantation from the same donor enhances graft function.

Purpose of the Study:

• To evaluate the outcomes of combined pancreas-kidney transplantation (CPKT) using bladder drainage.
• To assess graft function, rejection rates, and long-term effects on diabetic complications.

Main Methods:

• Analysis of a series of 50 CPKTs.
• Monitoring of 1-year graft function rates for both pancreas and kidney.
• Assessment of rejection episodes and therapy effectiveness.
• Evaluation of effects on glucose metabolism and diabetic complications.

Main Results:

• 1-year graft function rate of 88% for both organs in CPKT.
• High incidence of recurrent urinary tract infections associated with bladder drainage.
• Acute rejection episodes are initially high despite triple drug therapy and ATG prophylaxis.
• Monoclonal antibodies (e.g., OKT3) are effective for rejection therapy.
• Near-complete normalization of glucose metabolism post-transplantation.
• Positive effects on diabetic neuropathy confirmed; other late complications require long-term follow-up.
• Significant improvement in quality of life due to physical and psychological rehabilitation.

Conclusions:

• CPKT with bladder drainage offers excellent graft function and improves quality of life.
• Urinary tract infections and rejection episodes are significant challenges.
• Long-term benefits for diabetic complications are still under investigation.
• Isolated pancreatic transplantation has lower graft function rates and requires careful consideration of risks.