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Simultaneous Pancreas-Kidney Transplant After Bricker Loop Urinary Diversion: A Case Report
Dávid Á Kovács1, Andries E Braat, Volkert A L Huurman
1From the Leiden University Medical Centre, Department of Surgery, Division of Transplantation, Leiden, The Netherlands.
Summary
Simultaneous pancreas-kidney transplant can be successful in patients with type 1 diabetes and kidney failure, even with prior complex surgeries. This life-extending procedure offers improved quality of life by managing both conditions.
Area of Science:
- Transplantation immunology
- Nephrology
- Endocrinology
Background:
- Simultaneous pancreas-kidney transplant (SPKT) is a definitive treatment for type 1 diabetes mellitus (T1DM) with end-stage renal disease (ESRD).
- SPKT establishes a euglycemic environment, protecting the transplanted kidney from diabetic nephropathy recurrence.
- Patient history included multiple abdominal surgeries and urinary diversion (Bricker loop).
Observation:
- A 41-year-old woman with ESRD secondary to T1DM underwent SPKT.
- The patient experienced immediate graft function and stable glycemic control post-operatively.
- A complication of hydronephrosis occurred due to ureteral anastomosis edema, managed with percutaneous nephrostomy.
Findings:
- The patient's kidney function normalized (creatinine 102 μmol/L, eGFR 52 mL/min/1.73 m2) and remained stable.
- Postoperative serum glucose levels normalized and were maintained.
- Successful management of a postoperative complication demonstrated treatment feasibility.
Implications:
- Extensive prior abdominal surgeries, including Bricker diversion, are not absolute contraindications for SPKT.
- Careful case selection and tailored surgical approaches can lead to successful SPKT outcomes.
- SPKT can significantly improve quality of life and life expectancy in selected complex patients.
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