Evolution in pancreas transplantation techniques: Simultaneous kidney-pancreas transplantation using portal-enteric drainage without antilymphocyte induction

Objective To report initial experience with the combination of a novel tech nique of portal-enteric pancreas transplantation with newer immunosuppressi ve strategies that eliminate antilymphocyte induction therapy. Background A new surgical technique of pancreas transplantation has been de veloped with portal venous delivery of insulin and enteric drainage of the exocrine secretions (portal-enteric). The introduction of potent immunosupp ressive agents may allow simultaneous kidney and pancreas transplants (SKPT ) to be performed without antilymphocyte induction. Methods From September 1996 to November 1998, the authors performed 28 prim ary SKPTs with portal-enteric drainage and no antilymphocyte induction. All patients received triple immunosuppression with tacrolimus, mycophenolate mofetil, and steroids. The study group had a mean age of 38 years and a mea n preoperative duration of diabetes of 25 years. Four patients (14%) had pr ior kidney transplants. Results All patients had immediate renal allograft function. Actual patient , kidney, and pancreas graft survival rates were 86%, 82%, and 82%, respect ively, after a mean follow-up of 12 months. Four patients died, three as a result of cardiac events unrelated to SKPT. Five kidney and five pancreas g rafts were lost, including five deaths with function and three cases of chr onic rejection. The mean length of stay and total charges for the initial h ospital stay were 12.5 days and $99,517. The mean number of readmissions wa s 2.9, and 10 patients (38%) had no readmissions. Six patients (21%) develo ped acute rejection, with five (18%) receiving antilymphocyte therapy. Seve n patients (25%) underwent relaparotomy, including two (7%) for intraabdomi nal infection. Nine patients (32%) had major infections, including three (1 1%)with cytomegaloviral infection. Of the 24 surviving patients, 22 (92%) a re both dialysis- and insulin-free. Conclusion These preliminary results suggest that SKPT with portal-enteric drainage without antilymphocyte induction can be performed with excellent o utcomes.