Simultaneous Pancreas and Dual Kidney Transplantation from a Standard Criteria Donor: First Report From Korea

Organ shortage remains a global challenge in transplantation. In Korea, the waiting time for a kidney transplant from a brain-dead donor exceeds 7 years, and simultaneous pancreas-kidney (SPK) transplantation requires even longer. According to standard allocation principles, kidneys from standard criteria donors should be allocated to 2 recipients to maximize graft utilization. However, we encountered a rare case where a simultaneous pancreas and dual kidney transplantation was performed in a single recipient due to recipient unavailability and time constraints. A 46-year-old male with type 1 diabetes and end-stage renal disease received a pancreas and both kidneys from a 44-year-old brain-dead donor who was anti-HBV core antibody positive. During procurement, one kidney recipient tested positive for COVID-19, and no other eligible recipients were available. Hypothermic machine perfusion was not available, limiting preservation time. We proceeded with ipsilateral pancreas and kidney transplantation in the right iliac fossa, and transplanted the second kidney in the left retroperitoneal space through downward traction of the midline peritoneum. Postoperatively, graft function was favorable, although a pancreatic fistula required surgical repair. At 18-month follow-up, all grafts remained functional. The patient developed polycythemia, likely due to increased erythropoietin from 2 functioning kidneys. This case demonstrates the technical feasibility and clinical acceptability of simultaneous pancreas and dual kidney transplantation under exceptional circumstances. The institutional review board waived approval for this case report.