Related Experiment Videos
Experience with 100 consecutive simultaneous kidney-pancreas transplants with bladder drainage
H W Sollinger1, S J Knechtle, A Reed
1University of Wisconsin, School of Medicine, Department of Surgery, Madison.
Annals of Surgery
|December 1, 1991
Summary
Simultaneous pancreas-kidney (SPK) transplants achieved high patient and graft survival rates. Strategies were developed to mitigate surgical and medical complications, including infections and bleeding.
Area of Science:
- Nephrology
- Transplantation Surgery
- Immunology
Background:
- Simultaneous pancreas-kidney (SPK) transplantation is a complex procedure requiring careful management of immunosuppression and surgical techniques.
- Optimizing outcomes in SPK recipients involves minimizing both surgical complications and post-transplant infections.
Purpose of the Study:
- To review the outcomes of 100 consecutive SPK transplants performed between 1985 and 1989.
- To evaluate the effectiveness of different immunosuppressive regimens and surgical techniques.
- To identify strategies for preventing medical and surgical complications in SPK recipients.
Main Methods:
- Retrospective analysis of 100 consecutive SPK transplants.
- Comparison of Minnesota antilymphocyte globulin (MALG) versus OKT3 induction therapy.
- Evaluation of duodenal button versus duodenal segment techniques for pancreatic graft drainage.
- Assessment of bladder drainage technique for kidney and pancreas grafts.
Main Results:
- One- and three-year patient survival rates were 93% and 90%, respectively.
- One- and three-year kidney survival rates were 90% and 85%, respectively.
- One- and three-year pancreas survival rates were 86% and 84%, respectively.
- OKT3 induction was associated with more opportunistic infections compared to MALG.
- Duodenal segment technique resulted in fewer postoperative bleeding and infection complications than the duodenal button technique.
- Urine leak (13%) was the most common surgical complication with the duodenal segment technique.
- Hematuria (13%) was the most common urologic complication with bladder drainage.
- High incidence of urinary tract infections (84%) and opportunistic infections (25%) within six months post-transplant.
Conclusions:
- SPK transplantation can achieve excellent long-term patient and graft survival.
- Careful selection of surgical techniques and immunosuppressive strategies is crucial for minimizing complications.
- Prophylactic measures are necessary to address the high rates of infectious complications observed post-transplant.