Kidney and pancreas transplantation. Initial experience at a single transplant center in Argentina.

After more than 10,000 cases reported all over the world until 1998, simult aneous kidney and pancreas transplantation has become a safe clinical pract ice, and it may probably represent the best treatment available for diabeti c patients in end-stage renal disease. Here we present our results after 12 cadaveric pancreas transplants (8 whole organ, and 4 islet transplants), p erformed on insulin-dependent diabetic patients. Eleven of these patients r eceived a kidney simultaneously, and one of them required a kidney retransp lantation. All vascularised pancreatic grafts were positioned intraperitone ally, anastomosed to the iliac vessels, and bladder drained. One year patie nt, whole pancreas, and kidney survival rates were 86%, 86% and 71%, respec tively. All of these patients remain insulin and dialysis-free, the longest for 37 months. Islets for transplantation were obtained from single cadave ric donors. Fresh, unpurified cells were transplanted intraperitoneally by laparoscopy (equivalent islet yields: 3x10(5), 4x10(5), 1x10(6) and 5x10(5) ). None of the islet recipients resulted insulin-independent but they all r educed daily requirements in about 40%, with better metabolic control (mean HbA1c pretransplant 9.4 +/- 1.8, vs 7.9 +/- 1.6 posttransplant). One kidne y graft was lost due to venous thrombosis. Simultaneous kidney and pancreas transplantation offers the diabetic patient in end-stage renal disease a c hance of independence both from dialysis and exogenous insulin. Whole pancr eas transplantation has better functional outcome than islet transplantatio n. Nevertheless, for those diabetic patients who do not meet the criteria t o receive a vascularised graft, pancreatic cells may still improve carbohyd rate metabolism with minor surgical risk.