Kidney allograft outcome in simultaneous pancreas-kidney transplantation

Background: In simultaneous pancreas-kidney transplantation, with both orga ns coming from the same donor, the addition of a pancreas to the kidney tra nsplant does not jeopardize the kidney allograft outcome despite higher pos toperative SPR morbidity. Pancreas allograft outcome has recently improved due to better organ selection and more accurate surgical techniques. Objective: To demonstrate the positive impact of SPK on kidney allograft ou tcome versus kidney transplantation alone in insulin-dependent diabetes mel litus patients with end-stage renal failure. Methods: We performed 39 consecutive SPKs in 14 female and 25 male IDDM pat ients with renal failure after an average waiting time of 9 months. Multi-o rgan donor age was 30 years (range 12-53). The kidneys were transplanted in the left retroperitoneal iliac fossa following completion of the pancreas transplantation; kidney cold ischemia time was 16+/-4 hours. Induction anti -rejection therapy was achieved with polyclonal antithymocytic globulin and methylprednisolone, and maintenance immunosuppression by triple drug thera py (prednisone, cyclosporine or tacrolimus, and azathioprine or mycophenola te mofetil). Infection and rejection were closely monitored. Results: All kidney allografts produced immediate urinary output following SPK. Two renal grafts had mild function impairment due to acute tubular dam age but recovered after a short delay. Three patients died from myocardial infarction, cerebrovascular event and abdominal sepsis on days 1, 32 and 45 respectively (1 year patient survival 92%). An additional kidney allograft was lost due to a renal artery pseudo-aneurysm requiring nephrectomy on da y 26. Nineteen patients (49%) had an early rejection of the kidney that was resistant to pulse-steroid therapy in 6. No kidney graft was lost due to r ejection. Patients with acute kidney-pancreas rejection episodes suffered f rom severe infection, which was the main cause of morbidity with a 55% re-a dmission rate. Complications of the pancreas allograft included graft pancr eatitis and sepsis, leading to a poor kidney outcome with sub-optimal kidne y function at 1 year. Kidney graft survival at one year was 89% or 95% afte r censoring the data for patients who died with functioning grafts. Conclusions: Eligible IDDM patients with advanced diabetic nephropathy shou ld choose SPK over kidney transplantation alone from either a cadaver or a living source.