[Selection of surgical procedure of combined kidney-pancreatic transplantation]

Abstract

Objective: To evaluate simultaneous kidney-pancreatic transplantation (SKPT) with bladder drainage and enteric drainage for its efficacy and safety.

Method: SKPT was performed in 10 patients from Jan. 2000 to Feb. 2002. All patients had long-standing insulin-dependent diabetes mellitus and subsequent renal failure. Bladder drainage (BD) of exocrine secretion was used in the first 2 cases and enteric drainage (ED) in last 8 patients. In BD, a two-layer hand sewn duodenocystostomy was performed. In ED, a two-layered side-to-side anastomosis was fashioned between the donor duodenal segment and the recipient jejunum. No Roux-en-Y limb was used. Quadruple immunosuppressive therapy with antithymocyte globulin, tacrolimus, mycophenolate mofetil and steroids was standard treatment in all patients. The patients were treated with quadruple therapy, which included antilymphocyte globulin (ALG) or anti-CD25 monoclonal antibody (Zenapax) induction therapy, prednisone, Cyclosporine A/tacrolimus, and mycophenolat-mofetil (MMF).

Results: SPK was successfully applied to all cases without complication referable to the technique. All patients have achieved excellent renal function and euglycemia, and no further insulin treatment was needed between 1 and 5 days posttransplant. One patient with ED died due to sepsis and upper gastrointestinal hemorrhage 5 weeks after operation. The death occurred with functioning grafts. Until now no rejection episode and thrombosis were observed and all the grafts from nine patients are functioning well. The first 2 patients with BD underwent slight metabolic complications and microscopic hematuria with entire follow-up time. Two episodes of reflux graft pancreatitis followed by macroscopic hematuria occurred in one patient with BD.

Conclusion: Compared with SPK with BD, ED without Roux-en-Y anastomosis might be a more physiological and prior procedure for type I diabetes mellitus with uremia.