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. 1998 Sep;228(3):284–296. doi: 10.1097/00000658-199809000-00002

Experience with 500 simultaneous pancreas-kidney transplants.

H W Sollinger 1, J S Odorico 1, S J Knechtle 1, A M D'Alessandro 1, M Kalayoglu 1, J D Pirsch 1
PMCID: PMC1191479  PMID: 9742912

Abstract

METHODS: From December 1985 to October 1997, 500 simultaneous pancreas-kidney transplants (SPKs) were performed at the University of Wisconsin. Bladder drainage (BD) was used in 388 and enteric drainage (ED) in 112. All pancreas transplants were preserved in UW solution. RESULTS: Patient survival at 1, 5, and 10 years was 96.4%, 88.6%, and 76.3%; kidney function, 88.6%, 80.3%, and 66.6%; and pancreas function, 87.5%, 78.1%, and 67.2%. Thrombosis of the pancreas occurred in three to four (0.6% to 0.8%) and primary nonfunction in one (0.2%). There was a 4.2% acute tubular necrosis rate for the kidney. Conversion from BD to ED was required in 24% of cases. Primary indications for enteric conversion (EC) were leak (14%), urethritis and extravasation (7%), and chronic hematuria (3%). No graft was lost as a result of EC. There was no difference in 1-year graft survival between ED and BD. Leading causes of pancreas loss were rejection in 45 patients and death with a functioning graft in 27 patients. Since June 1995, mycophenolate mofetil was used for immunosuppression (n = 109). One-year survival rates with mycophenolate mofetil are patient, 98.1 %; kidney, 94.2%; and pancreas, 93.1%. Steroid-resistant rejections decreased from 48% to 15%. CONCLUSIONS: This series represents the world's largest experience with SPK, including the longest follow-up for BD pancreatic transplants. Ten-year graft survival rates exceed those of all other transplants, with the exception of HLA-identical living-related grafts. This series confirms that SPK is a highly successful procedure for selected diabetic patients with renal failure.

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Selected References

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  1. Akiyama N., Okumura K., Watanabe Y., Hashimoto H., Ito T., Ogawa K., Satake T. Altered acetylcholine and norepinephrine concentrations in diabetic rat hearts. Role of parasympathetic nervous system in diabetic cardiomyopathy. Diabetes. 1989 Feb;38(2):231–236. doi: 10.2337/diab.38.2.231. [DOI] [PubMed] [Google Scholar]
  2. Bilous R. W., Mauer S. M., Sutherland D. E., Najarian J. S., Goetz F. C., Steffes M. W. The effects of pancreas transplantation on the glomerular structure of renal allografts in patients with insulin-dependent diabetes. N Engl J Med. 1989 Jul 13;321(2):80–85. doi: 10.1056/NEJM198907133210204. [DOI] [PubMed] [Google Scholar]
  3. Cook K., Sollinger H. W., Warner T., Kamps D., Belzer F. O. Pancreaticocystostomy: an alternative method for exocrine drainage of segmental pancreatic allografts. Transplantation. 1983 Jun;35(6):634–636. [PubMed] [Google Scholar]
  4. D'Alessandro A. M., Hoffmann R. M., Knechtle S. J., Eckhoff D. E., Love R. B., Kalayoglu M., Sollinger H. W., Belzer F. O. Successful extrarenal transplantation from non-heart-beating donors. Transplantation. 1995 Apr 15;59(7):977–982. doi: 10.1097/00007890-199504150-00009. [DOI] [PubMed] [Google Scholar]
  5. D'Alessandro A. M., Sollinger H. W., Stratta R. J., Kalayoglu M., Pirsch J. D., Belzer F. O. Comparison between duodenal button and duodenal segment in pancreas transplantation. Transplantation. 1989 Jan;47(1):120–122. doi: 10.1097/00007890-198901000-00026. [DOI] [PubMed] [Google Scholar]
  6. D'Alessandro A. M., Stratta R. J., Sollinger H. W., Kalayoglu M., Pirsch J. D., Belzer F. O. Use of UW solution in pancreas transplantation. Diabetes. 1989 Jan;38 (Suppl 1):7–9. doi: 10.2337/diab.38.1.s7. [DOI] [PubMed] [Google Scholar]
  7. Groth C. G., Collste H., Lundgren G., Wilczek H., Klintmalm G., Ringdén O., Gunnarsson R., Ostman J. Successful outcome of segmental human pancreatic transplantation with enteric exocrine diversion after modifications in technique. Lancet. 1982 Sep 4;2(8297):522–524. doi: 10.1016/s0140-6736(82)90601-8. [DOI] [PubMed] [Google Scholar]
  8. Kelly W. D., Lillehei R. C., Merkel F. K., Idezuki Y., Goetz F. C. Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy. Surgery. 1967 Jun;61(6):827–837. [PubMed] [Google Scholar]
  9. Kiebert G. M., van Oosterhout E. C., van Bronswijk H., Lemkes H. H., Gooszen H. G. Quality of life after combined kidney-pancreas or kidney transplantation in diabetic patients with end-stage renal disease. Clin Transplant. 1994 Jun;8(3 Pt 1):239–245. [PubMed] [Google Scholar]
  10. Melzer J. S., D'Alessandro A. M., Kalayoglu M., Pirsch J. D., Belzer F. O., Sollinger H. W. The use of OKT3 in combined pancreas-kidney allotransplantation. Transplant Proc. 1990 Apr;22(2):634–635. [PubMed] [Google Scholar]
  11. Nghiem D. D., Corry R. J. Technique of simultaneous renal pancreatoduodenal transplantation with urinary drainage of pancreatic secretion. Am J Surg. 1987 Apr;153(4):405–406. doi: 10.1016/0002-9610(87)90588-5. [DOI] [PubMed] [Google Scholar]
  12. Solders G., Tydén G., Persson A., Groth C. G. Improvement of nerve conduction in diabetic neuropathy. A follow-up study 4 yr after combined pancreatic and renal transplantation. Diabetes. 1992 Aug;41(8):946–951. doi: 10.2337/diab.41.8.946. [DOI] [PubMed] [Google Scholar]
  13. Sollinger H. W., Messing E. M., Eckhoff D. E., Pirsch J. D., D'Alessandro A. M., Kalayoglu M., Knechtle S. J., Hickey D., Belzer F. O. Urological complications in 210 consecutive simultaneous pancreas-kidney transplants with bladder drainage. Ann Surg. 1993 Oct;218(4):561–570. doi: 10.1097/00000658-199310000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Sollinger H. W. Mycophenolate mofetil for the prevention of acute rejection in primary cadaveric renal allograft recipients. U.S. Renal Transplant Mycophenolate Mofetil Study Group. Transplantation. 1995 Aug 15;60(3):225–232. doi: 10.1097/00007890-199508000-00003. [DOI] [PubMed] [Google Scholar]
  15. Sollinger H. W. Pancreatic transplantation and vascular graft thrombosis. J Am Coll Surg. 1996 Apr;182(4):362–363. [PubMed] [Google Scholar]
  16. Sollinger H. W., Sasaki T. M., D'Alessandro A. M., Knechtle S. J., Pirsch J. D., Kalayoglu M., Belzer F. O. Indications for enteric conversion after pancreas transplantation with bladder drainage. Surgery. 1992 Oct;112(4):842–846. [PubMed] [Google Scholar]
  17. Sollinger H. W., Vernon W. B., D'Alessandro A. M., Kalayoglu M., Stratta R. J., Belzer F. O. Combined liver and pancreas procurement with Belzer-UW solution. Surgery. 1989 Oct;106(4):685–691. [PubMed] [Google Scholar]
  18. Wahlberg J. A., Love R., Landegaard L., Southard J. H., Belzer F. O. 72-hour preservation of the canine pancreas. Transplantation. 1987 Jan;43(1):5–8. doi: 10.1097/00007890-198701000-00002. [DOI] [PubMed] [Google Scholar]
  19. Wang Q., Klein R., Moss S. E., Klein B. E., Hoyer C., Burke K., Sollinger H. W. The influence of combined kidney-pancreas transplantation on the progression of diabetic retinopathy. A case series. Ophthalmology. 1994 Jun;101(6):1071–1076. doi: 10.1016/s0161-6420(94)31216-4. [DOI] [PubMed] [Google Scholar]

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