200 CONSECUTIVE SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTS WITH BLADDERDRAINAGE

Background. Since 1,982, 288 pancreas transplantations have been perfo rmed at the University of Wisconsin. This report reviews our experienc e with 200 consecutive simultaneous pancreas-kidney (SPK) transplantat ions during a 7-year period. Methods. Two hundred consecutive SPK tran splantations were performed between December 1985 to October 1992. Imm ediate posttransplant function and surgical and infectious complicatio ns were evaluated. Frequency of rejection episodes were analyzed, as w as 5-year patient and graft survival. Results. All but four pancreas t ransplants functioned immediately after transplantation. Three pancrea s transplants failed because of thrombosis and one from primary nonfun ction. Five-year patient survival was 90.2%, kidney survival 80.3%, an d pancreas survival 78.6%. There were 54 surgical complications. Fifte en patients have died since 1985. The most frequent cause of death was infection (three patients). A total of 678 infectious episodes were r ecorded. Urinary tract infection (n = 344) was the most frequent type of infection. Enteric conversion was necessary in 35 patients, with th e most frequent indication being a leak of the duodenal segment. Concl usions. We concluded from this series that SPK transplantation is asso ciated with higher cost and morbidity as compared with kidney transpla ntation alone. However, excellent long-term survival in combination wi th the clearly demonstrated benefits for secondary diabetic complicati ons indicate that SPK transplantation is the procedure of choice for c arefully selected patients with diabetes.