Simultaneous cadaver pancreas living-donor kidney transplantation: A new approach for the type 1 diabetic uremic patient

Objective To review the authors' experience with a new approach for type I diabetic u remic patients: simultaneous cadaver-donor pancreas and living-donor kidney transplant (SPLK). Summary Background Data Simultaneous cadaver kidney and pancreas transplantation (SPK) and living-d onor kidney transplantation alone followed by a solitary cadaver-donor panc reas transplant (PAK) have been the transplant options for type I diabetic uremic patients. SPK pancreas graft survival has historically exceeded that of solitary pancreas transplantation. Recent improvement in solitary pancr eas transplant survival rates has narrowed the advantage seen with SPK. PAK , however, requires sequential transplant operations. In contrast to PAK an d SPK, SPLK is a single operation that offers the potential benefits of liv ing kidney donation: shorter waiting time, expansion of the organ donor poo l, and improved short-term and long-term renal graft function. Methods Between May 1998 and September 1999, the authors performed 30 SPLK procedur es, coordinating the cadaver pancreas transplant with simultaneous transpla ntation of a laparoscopically removed living-donor kidney. Of the 30 SPLKs, 28 (93%) were portally and enterically drained. During the same period, th e authors also performed 19 primary SPK and 17 primary PAK transplants. Results One-year pancreas, kidney, and patient survival rates were 88%, 95%, and 95 % for SPLK recipients. One-year pancreas graft survival rates in SPK and PA K recipients were 84% and 71%. Of 30 SPLK transplants, 29 (97%) had immedia te renal graft function, whereas 79% of SPK kidneys had immediate function. Reoperative rates, early readmission to the hospital, and initial length o f stay were similar between SPLK and SPK recipients. SPLK recipients had a shorter wait time for transplantation. Conclusions Early pancreas, kidney, and patient survival rates after SPLK are similar t o those for SPK. Waiting time was significantly shortened. SPLK recipients had lower rates of delayed renal graft function than SPK recipients. Combin ing cadaver pancreas transplantation with living-donor kidney transplantati on does not harm renal graft outcome. Given the advantages of living-donor kidney transplant, SPLK should be considered for all uremic type I diabetic patients with living donors.