SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION FROM LIVE DONORS

Objective In this first report of a clinical series of simultaneous pa ncreas-kidney transplants (SPKs) from live donors, the authors assess donor and recipient outcome as well as the spectrum of surgical and me tabolic complications. Summary Background Data The rationale for live (vs. cadaveric) donation includes an immunologic advantage (better mat ching, decreased drugs, and fewer rejection episodes) and elimination of waiting time. Only sequential kidney and pancreas or pancreas trans plants alone from live donors had been done until the authors' current series. Methods Between March 15, 1994, and March 15, 1997, the autho rs performed 20 SPKs from live donors (6 human leukocyte antigen-ident ical siblings, 14 mismatched relatives [5 parents, 7 siblings, 1 daugh ter, 1 aunt]). Of the 20 donors, 13 were women, and 7 were men; median age was 43 years (range, 30-58 years). All donors underwent standardi zed metabolic workup, including oral glucose tolerance tests, determin ation of hemoglobin A1c levels, and tests to study insulin secretion a nd functional insulin secretory reserve. Of the 20 recipients, 12 were women, and 8 were men; median age was 34 years (range, 14-50 years). Management of exocrine pancreatic secretions was with bladder drainage in 17 and duct injection in 3 recipients. Median follow-up was 9 mont hs (range, 1-36 months). Results Currently, all 20 kidney grafts are f unctioning. Of the 20 pancreas grafts, 15 are functioning, 3 thrombose d, but 2 of those patients underwent immediate retransplantation from a cadaveric donor, and their grafts currently are functioning. Recipie nt complications included three anastomotic leaks and three intra-abdo minal abscesses. Donor complications included four splenectomies, two peripancreatic fluid collections, one pseudocyst, and one intra-abdomi nal abscess; two donors underwent reoperation. Three donors had impair ed glucose metabolism postdonation. Using tacrolimus and mycophenolate mofetil for mainstay immunosuppression, only 8 of 20 recipients exper ienced greater than or equal to 1 rejection episode; only 1 pancreas g raft was lost to rejection. Donor and recipient mortality was 0%. Conc lusion Simultaneous pancreas-kidney transplants from live donors can b e done with no mortality and good graft outcome. With stringent donor criteria, this approach could become another surgical alternative for endocrine replacement therapy in selected patients with uremic type I diabetes.