SUCCESSFUL SIMULTANEOUS TRANSPLANTATION OF KIDNEY AND FETAL PANCREATIC-ISLET MASSES

This paper reports our experience with the successful simultaneous tra nsplantation of kidney and fetal pancreatic islets in a 46-year-old di abetic man. No detectable C-peptide level was noted and the end-stage nephropathy required hemodialyis. The cadaver kidney and two masses of 8-week-cultured fetal islets were grafted simultaneously. After revas cularization of the kidney, the islet masses were placed under the kid ney capsule. Following transplantation, islet function was demonstrate d by a higher C-peptide level, which subsequently persisted, Twenty-fo ur months after grafting, islet function was provoked by glucagon and glucose, which led to elevations in the C-peptide and insulin levels. The insulin requirement fell from 58 to 24 U/day during the post-trans plant period of 24 months. The mean value of HbA(1c) (5.6 % +/- 0.3 %) indicated a constantly normal carbohydrate metabolism. Improvements i n retinopathy were also noted. Three periods of kidney rejection were diagnosed, but these proved reversible with high-dose steroid treatmen t. The serum and urine beta-2-microglobulin levels correlated well wit h rejection and recovery. More than 2 years after grafting, kidney fun ction is in the normal range. On sonography, the transplanted islet ma sses were repeatedly clearly visible, and 24 months following transpla ntation the volume was twice the original one. The results indicate th at simultaneous kidney and fetal pancreatic islet grafting is advantag eous in end-stage nephropathy secondary to type I diabetes mellitus.