Pancreas after kidney transplants

Background: For certain uremic diabetic patients, a sequential transplant o f a kidney (usually from a living donor) followed by a cadaver pancreas has become an attractive alternative to a simultaneous transplant of both orga ns. The purpose of this study was to compare outcomes with simultaneous pan creas-kidney (SPK) versus pancreas after kidney (PAK) transplants to determ ine advantages and disadvantages of the two procedures. Methods: Between January 1, 1994, and June 30, 2000, we performed 398 cadav er pancreas transplants at our center. Of these, 193 were SPK transplants a nd 205 were PAK transplants. We compared these two groups with regard to se veral endpoints, including patient and graft survival rates, surgical compl ications, acute rejection rates, waiting times, length of hospital stay, an d quality of life. Results: Overall, surgical complications were more common for SPK recipient s. The total relaparotomy rate was 25.9% for SPK recipients versus 15.1% fo r PAK recipients (P = 0.006). Leaks, intraabdominal infections, and wound i nfections were all significantly more common in SPK recipients (P = 0.009, P = 0.05, and P = 0.01, respectively, versus PAK recipients). Short-term pa ncreas graft survival rates were similar between the two groups: at 1 year posttransplant, 78.0% for SPK recipients and 77.9% for PAK recipients (P = not significant). By 3 years, however, pancreas graft survival differed bet ween the two groups (74.1% for SPK and 61.7% for PAK recipients), although this did not quite reach statistical significance (P = 0.15). This differen ce in graft survival seemed to be due to increased immunologic losses for P AK recipients: at 3 years posttransplant, the incidence of immunologic graf t loss was 16.2% for PAK versus 5.2% for SPK recipients (P = 0.01). Kidney graft survival rates were, however, better for PAK recipients. At 3 years a fter their kidney transplant, kidney graft survival rates were 83.6% for SP K and 94.6% for PAK recipients (P = 0.001). The mean waiting time to receiv e the pancreas transplant was 244 days for SPK and 167 days for PAK recipie nts (P = 0.001). Conclusions: PAK transplants are a viable option for uremic diabetics. Whil e long-term pancreas graft results are slightly inferior to SPK transplants , the advantages of PAK transplants include the possibility of a preemptive living donor kidney transplant, better long-term kidney graft survival, si gnificantly decreased waiting times, and decreased surgical complication ra tes. Use of a living donor for the kidney transplant expands the donor pool . Improvements in immunosuppressive. regimens will hopefully eliminate some of the difference in long-term pancreas graft survival between SPK and PAK transplants. (C) 2001 Excerpta Medica, Inc. All rights reserved.