Simultaneous cadaver renal and pancreas transplantation in type I diabetes

P. J. Garvin, M. Castaneda and K. Carney

Between February 1985 and April 1986, we performed 11 simultaneous cadaver kidney and segmental pancreatic transplants in patients with type I diabetes. There were nine men and two women ranging in age from 25 to 47 years (mean, 38.5 years). All pancreatic grafts were extraperitoneal, and the pancreatic duct was managed by pancreaticocystostomy utilizing an internal stent. Three patients died from two to six weeks postoperatively of septic complications. Four pancreatic grafts were functioning at 2, 5, 11, and 14 months after operation, and eight patients had had functioning renal allografts from two to 14 months (mean, 6.8 months) with a mean serum creatinine level of 2.4 mg/dL (210 mumol/L). Graft failure occurred in the other four patients from vascular thrombosis (three patients) or hemorrhagic pancreatitis (one patient). Significant morbidity included an infected arterial anastomosis (two patients), pancreatic fistulas (four patients), and bladder leak (four patients). In conclusion, this procedure is an effective option for selective diabetics with end-stage renal disease. Although technical complications were frequent, no adverse effect on renal allograft function was evident. With technical refinements, this procedure should be applicable to most type I diabetics with renal failure.