Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1988 Oct;208(4):475–483. doi: 10.1097/00000658-198810000-00009

Experience with simultaneous pancreas-kidney transplantation.

H W Sollinger 1, R J Stratta 1, A M D'Alessandro 1, M Kalayoglu 1, J D Pirsch 1, F O Belzer 1
PMCID: PMC1493739  PMID: 3052327

Abstract

With refinements in surgical techniques and increased clinical experience, there has been a resurgence of interest in vascularized pancreas transplantation. From December 1986 to April 1988, 30 whole-organ vascularized pancreas transplants with pancreatico duodenocystostomy were performed simultaneously with renal transplantation. The recipient population consisted of 20 men and ten women, with a mean age of 34.7 years (range of 25-53 years). The mean duration of insulin-dependent diabetes mellitus (IDDM) was 22.6 years (range of 10-37 years). The mean pancreas preservation time was 8.7 hours (range 3-19 years). All patients were immediately insulin-independent. Simultaneous pancreas-kidney engraftment was performed to both iliac fossae via a lower midline incision (n = 28) or through a bilateral lower abdominal incision (n = 2). The mean operating time was 5.9 hours, and packed cell transfusion requirement was 1.3 units. The mean length of hospital stay was 27.4 days. Recipients averaged 2.3 admissions (1-7), with ten patients (34.4%) requiring only one hospital admission. Postoperative immunosuppression consisted of cyclosporine, prednisone, azathioprine, and Minnesota antilymphoblast globulin (MALG). A total of 49 episodes of rejection occurred in 26 patients. Actuarial patient survival rate at two years is 96.3%. The kidney and pancreas survival rates for the same time interval is 94.0% and 84.0%, respectively. Mean serum creatinine at present is 1.75 mg/dl. In conclusion, renal transplantation in concert with pancreas transplantation has a dramatic positive impact on pancreas allograft survival. Combined engraftment does not appear to jeopardize renal allograft functional survival. In view of these results, simultaneous pancreas-kidney transplantation appears to be the treatment of choice for Type I diabetic patients.

Full text

PDF
475

Images in this article

477Fig. 1.
on p.477

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bohman S. O., Tydén G., Wilczek H., Lundgren G., Jaremko G., Gunnarsson R., Ostman J., Groth C. G. Prevention of kidney graft diabetic nephropathy by pancreas transplantation in man. Diabetes. 1985 Mar;34(3):306–308. doi: 10.2337/diab.34.3.306. [DOI] [PubMed] [Google Scholar]
  2. 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]
  3. Corry R. J., Nghiem D. D., Schulak J. A., Beutel W. D., Gonwa T. A. Surgical treatment of diabetic nephropathy with simultaneous pancreatic duodenal and renal transplantation. Surg Gynecol Obstet. 1986 Jun;162(6):547–555. [PubMed] [Google Scholar]
  4. Frisk B., Hedman L., Andersson C., Blohmé I., Karlberg I., Nyberg G., Persson H., Brynger H. The pancreas transplant program--Gothenburg, Sweden. Transplant Proc. 1987 Aug;19(4 Suppl 4):29–32. [PubMed] [Google Scholar]
  5. Kalayoglu M., Sollinger H. W., Stratta R. J., D'Alessandro A. M., Hoffmann R. M., Pirsch J. D., Belzer F. O. Extended preservation of the liver for clinical transplantation. Lancet. 1988 Mar 19;1(8586):617–619. doi: 10.1016/s0140-6736(88)91416-x. [DOI] [PubMed] [Google Scholar]
  6. Land W., Landgraf R., Illner W. D., Abendroth D., Kampik A., Jensen U., Lenhart F. P., Burg D., Hillebrand G., Castro L. A. Clinical pancreatic transplantation using the prolamine duct occlusion technique--the Munich experience. Transplant Proc. 1987 Aug;19(4 Suppl 4):75–83. [PubMed] [Google Scholar]
  7. 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]
  8. Prieto M., Sutherland D. E., Fernandez-Cruz L., Heil J., Najarian J. S. Experimental and clinical experience with urine amylase monitoring for early diagnosis of rejection in pancreas transplantation. Transplantation. 1987 Jan;43(1):73–79. doi: 10.1097/00007890-198701000-00017. [DOI] [PubMed] [Google Scholar]
  9. Pyke D. Pancreas transplantation for diabetes? Lancet. 1988 Apr 9;1(8589):816–817. doi: 10.1016/s0140-6736(88)91670-4. [DOI] [PubMed] [Google Scholar]
  10. Ramsay R. C., Goetz F. C., Sutherland D. E., Mauer S. M., Robison L. L., Cantrill H. L., Knobloch W. H., Najarian J. S. Progression of diabetic retinopathy after pancreas transplantation for insulin-dependent diabetes mellitus. N Engl J Med. 1988 Jan 28;318(4):208–214. doi: 10.1056/NEJM198801283180403. [DOI] [PubMed] [Google Scholar]
  11. Solders G., Wilczek H., Gunnarsson R., Tydén G., Persson A., Groth C. G. Effects of combined pancreatic and renal transplantation on diabetic neuropathy: a two-year follow-up study. Lancet. 1987 Nov 28;2(8570):1232–1235. doi: 10.1016/s0140-6736(87)91851-4. [DOI] [PubMed] [Google Scholar]
  12. Sollinger H. W., Cook K., Kamps D., Glass N. R., Belzer F. O. Clinical and experimental experience with pancreaticocystostomy for exocrine pancreatic drainage in pancreas transplantation. Transplant Proc. 1984 Jun;16(3):749–751. [PubMed] [Google Scholar]
  13. Sollinger H. W., Stratta R. J., Kalayoglu M., Belzer F. O. The University of Wisconsin experience in pancreas transplantation. Transplant Proc. 1987 Aug;19(4 Suppl 4):48–54. [PubMed] [Google Scholar]
  14. Sollinger H. W., Stratta R. J., Kalayoglu M., Pirsch J. D., Belzer F. O. Pancreas transplantation with pancreaticocystostomy and quadruple immunosuppression. Surgery. 1987 Oct;102(4):674–679. [PubMed] [Google Scholar]
  15. Tydén G., Brattstrom C., Lundgren G., Wilczek H., Bolinder J., Gunnarsson R., Ostman J., Groth C. G. Pancreatic transplantation with enteric exocrine diversion--the Stockholm experience. Transplant Proc. 1987 Aug;19(4 Suppl 4):86–91. [PubMed] [Google Scholar]
  16. 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]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES