Pancreas-kidney transplantation: analysis of 55 cases from 1987 to 2005

Abstract

The whole pancreas graft and islet cell transplantation are the only therapeutic options capable to restore euglicemic status in Type 1 diabetic patients. Pancreas transplantation presented a great improvement in the last years, although it continues to be a complex procedure, associated to significant morbidity and mortality. Objective: The authors present their pionnering experience with pancreas transplantation for the last 18 years, emphasizing the results. Method: From 7/1987 to 1/2005 53 simultaneous pancreas/kidney (SPK) and two pancreas after kidney (PAK) transplants have been performed. In the first phase (1987 to 1998) 9 SPK and 1 PAK were performed; in second phase (2000 to 2005), 44 SPK and 1 PAK. Results: Ages ranged from 17 to 49 (mean 31,8). Hemodialysis was the renal replacement therapy in 70,9% and peritonial dialysis, in 20%. Two-year actuarial survival in second phase was 81%, 77% and 71% for patients, kidney and pancreas allografts. A statistically significant difference was demonstrated in kidney graft survival between first and second phase patients (log rank=0,03). Conclusion: The strict preoperative selection of patients, associated to better surgical approach and better immunosuppressive drugs improved either survival as the quality of life of those patients.