Long-term outcomes in simultaneous kidney-pancreas transplant recipients with portal-enteric versus systemic-bladder drainage

We retrospectively reviewed long-term outcomes in simultaneous kidney-pancr eas transplant (SKPT) recipients with portal-enteric (P-E) versus systemic- bladder (S-B) drainage. Forty-five patients were alive with functioning gra fts 1 year after SKPT and were followed up for a minimum of 3 years (mean, 5.9 years), including 26 patients with P-E drainage and 19 patients with S- B drainage. Recipient demographic and transplant characteristics were simil ar between the two groups. In both groups, hospital admissions decreased si gnificantly with increasing time after SKPT, although significantly fewer r eadmissions occurred in the first year in the P-E than the S-B group. The m ost common reason for readmission in both groups was infection, followed by miscellaneous, surgical, and immunologic morbidity. The incidence of readm ission for dehydration was significantly less in the P-E group (P < 0.01). Mean systolic and diastolic blood pressures were similar between groups, al though the number of antihypertensive medications was significantly less in the S-B group. Although fasting C-peptide levels were significantly greate r in the S-B group, the two groups were similar with regard to carbohydrate (fasting serum glucose, hemoglobin Al,) and lipid (total cholesterol) meta bolism. Renal and pancreas allograft functions were similar between the two groups. At 1 year post-SKPT, stabilization in most diabetic complications was reported. Four quality-of-life surveys that provided 29 scores were com pleted 6 to 24 months (mean, 18.5 months) after SKPT. Improved quality of l ife was reported in all but one of the scales, with many dimensions showing significant improvements. At 3 years after SKPT, no activity limitation wa s reported in 76% of patients with P-E drainage versus 53% with S-B drainag e (P = 0.11). Five-year actual patient, kidney, and pancreas graft survival rates after P-E versus S-B drainage are 92% and 84%, 81% and 79%, and 88% and 74%, respectively (P = not significant). SKPT with P-E drainage is a sa fe and effective method to treat advanced diabetic nephropathy and is assoc iated with decreasing morbidity, improving rehabilitation and quality of li fe, and stablizing metabolic function over time, The long-term prognosis af ter the first year is excellent and at least similar to the results achieve d with S-B drainage. (C) 2001 by the National Kidney Foundation, Inc.