Simultaneous transplantation of pancreas and kidney in patients with advanced diabetic complications

From June 1983 to October 1985, 25 uremic diabetic patients aged 24 to 52 (mean 38) years were treated with combined pancreas and kidney transplantation. Mean duration of diabetes was 24 years, and end-stage renal disease was associated with severe extrarenal diabetic complications in all recipients. All transplants were harvested from cadaveric, heart-beating donors aged 5-55 years. The segmental pancreas transplant was duct-occluded with neoprene before it was transplanted to the left iliac fossa. Immunosuppressive treatment was given with cyclosporine and steroids in all cases while azathioprine was added in the last 5 cases. The one year survival of patient, kidney and pancreas was 96, 79 and 60 per cent respectively. Of 17 patients with functioning pancreas transplants, 13 are insulin independent and have normal or near normal glucose homeostasis. Based on the excellent patient survival and the improvement in quality of life experienced by the recipients, it is concluded that simultaneous transplantation of pancreas and kidney should be the treatment of choice for uremic diabetic patients when a living related kidney donor is unavailable.