Experience with 500 simultaneous pancreas-kidney transplants

Area of Science:

• Nephrology
• Transplantation Surgery
• Endocrinology

Background:

• Diabetic nephropathy is a leading cause of end-stage renal disease.
• Simultaneous pancreas-kidney transplantation (SPK) is a viable treatment option for select diabetic patients with renal failure.
• Long-term outcomes of SPK procedures require continuous evaluation.

Purpose of the Study:

• To evaluate the long-term outcomes of simultaneous pancreas-kidney transplantation (SPK).
• To compare outcomes between bladder drainage (BD) and enteric drainage (ED) techniques.
• To assess the impact of newer immunosuppression protocols on SPK success.

Main Methods:

• A retrospective analysis of 500 SPK procedures performed between December 1985 and October 1997.
• Comparison of outcomes between patients receiving bladder drainage (n=388) and enteric drainage (n=112).
• Evaluation of graft and patient survival, graft function, and complications.

Main Results:

• Ten-year patient survival was 76.3%, kidney graft survival was 66.6%, and pancreas graft survival was 67.2%.
• Enteric conversion was required in 24% of cases, primarily for leaks, without graft loss.
• Introduction of mycophenolate mofetil improved one-year survival rates to 98.1% (patient), 94.2% (kidney), and 93.1% (pancreas), reducing steroid-resistant rejections.

Conclusions:

• SPK is a highly successful procedure for selected diabetic patients with renal failure.
• Long-term graft survival rates for SPK exceed those of most other transplant types.
• The study represents the world's largest experience with SPK, including the longest follow-up for BD pancreatic transplants.