Simultaneous pancreas-kidney transplantation: lessons learned from the initial experience of a single center in Korea

Abstract

PurposeThe purpose of this study is to report the results of simultaneous pancreas-kidney (SPK) transplantations and describe the lessons learned from the early experiences of a single center.MethodsBetween January 2002 and June 2013, a total of 8 patients underwent SPK transplantation. Clinical and radiologic data were reviewed retrospectively.ResultsSeven patients were diagnosed with type I diabetes mellitus and one patient became insulin-dependent after undergoing a total pancreatectomy because of trauma. Pancreas exocrine drainage was performed by enteric drainage in 4 patients and bladder drainage in 4 patients. Three patients required conversion from initial bladder drainage to enteric drainage due to urinary symptoms and duodenal leakage. Four patients required a relaparotomy due to hemorrhage, ureteral stricture, duodenal leakage, and venous thrombosis. There was no kidney graft loss, and 2 patients had pancreas graft loss because of venous thrombosis and new onset of type II diabetes mellitus. With a median follow-up of 76 months (range, 2-147 months), the death-censored graft survival rates for the pancreas were 85.7% at 1, 3, and 5 years and 42.9% at 10 years. The patient survival rate was 87.5% at 1, 3, 5, and 10 years.ConclusionThe long-term grafts and patient survival in the current series are comparable to previous studies. A successful pancreas transplant program can be established in a single small-volume institute. A meticulous surgical technique and early anticoagulation therapy are required for further improvement in the outcomes.

Relative survival and quality of life benefits of pancreas–kidney transplantation, deceased kidney transplantation and dialysis in type 1 diabetes mellitus—a probabilistic simulation model

“…Current solid organ transplant options include kidney transplantation alone (from either a live or a deceased donor), simultaneous pancreas and kidney transplantation (SPK), or pancreas after kidney transplantation (PAK). Of these, SPK is an established treatment for patients with type 1 diabetes mellitus who progress to the point of requiring renal replacement therapy [4], because it improves survival and overall quality of life compared to being on dialysis [5,6]. The improved quality of life is due to freedom from dialysis, frequent blood sugar monitoring and insulin therapy, and by achieving euglycaemia, there may be fewer long‐term complications of diabetes [7].…”

Technical factors that minimize the occurrence of early graft failure in pancreas transplantation

“…However, the other centers for pancreas transplant in Korea, which share the same donor pool, experienced graft thromboses, threatening graft survival even though they used intensive anticoagulation. [25][26][27][28][29] The 1-year and 3-year graft survival rate of pancreas transplant in other centers of Korea during the same period (2015∼2019) were 89.0% and 84.9%, respectively. 30 This F I G U R E 7 A large and deep ulcer on the graft duodenum with raised borders and covered with fibrinous exudates was observed on endoscopy in all patients with graft failure.…”

“…Indeed, the short cold ischemic time, lean body mass of the donor and recipient, and low pDRI affected our excellent results. However, the other centers for pancreas transplant in Korea, which share the same donor pool, experienced graft thromboses, threatening graft survival even though they used intensive anticoagulation 25–29 . The 1‐year and 3‐year graft survival rate of pancreas transplant in other centers of Korea during the same period (2015∼2019) were 89.0% and 84.9%, respectively 30 .…”