THE UTILITY OF RETROPERITONEAL KIDNEY PLACEMENT IN SIMULTANEOUS KIDNEY-PANCREAS TRANSPLANTATION

Simultaneous kidney-pancreas (SPK) transplantation has become an accep ted therapeutic modality for patients with Type I diabetes mellitus-me diated end-stage renal disease (ESRD). However, the intraperitonel pla cement of the renal allograft may pose technical problems when attempt ing percutaneous biopsy or Doppler ultrasound examination. Recently, t he Stanford University Transplant Center adopted the technique of retr operitoneal placement of the renal allograft with intraperitonel place ment of the pancreas allograft (RETRO). From August 1993 to August 199 4, a total of 12 patients underwent SPK with this new technique. Twelv e patients who had received SPK with the standard technique served as historical controls (INTRA). Demographic data, followup, operative tim e, creatinine and amylase on discharge, length of stay, intraoperative fluid requirements, rejection episodes, thrombotic complications, inf ections, and number of open and closed renal biopsies were compared be tween the two groups. Average length df follow-up was greater in the I NTRA group (29.3 +/- 1.7 vs. 15.9 +/- 1.1 months). In addition, the RE TRO group had significantly fewer open renal biopsies (1/15) in compar ison to the INTRA group (7/12) (p < 0.001). The two groups otherwise d id not dilfer in any of the parameters studied. We conclude that retro peritoneal kidney and intraperitoneal pancreas allograft placement is associated with a significantly decreased requirement for open renal b iopsy with its associated operating room and anesthetic costs. In addi tion, the option of transcystoscopic or percutaneous needle biopsy of the pancreas allograft is preserved. This technique should be consider ed as an alternative to intraperitoneal placement of both the pancreas and renal allografts.