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A Safe and Effective Treatment for Diabetic Nephropathy

James A. Schulak, MD; James T. Mayes, MD; Donald E. Hricik, MD

Arch Surg. 1990;125(7):881-885.

Abstract
• Seventeen patients with type I diabetes and diabetic nephropathy underwent combined kidney and pancreas transplantation. Mean age was 32±6 years and average duration of diabetes was 21 ±6 years. Transplantation was performed through bilateral iliac fossa incisions, and graft duodenocystostomy was used to achieve exocrine pancreas drainage. The actuarial patient and kidney survival rate was 92% and the pancreas survival rate, 88% (follow-up of 3 to 28 months). One patient with functioning grafts died at 10 months owing to a cardiac arrhythmia and one pancreas was "lost" to early thrombosis. Major morbidity was due to pancreas wound infection (53%) that required reoperatlon, but all patients have had subsequent healing of their wounds. Rehabilitation with return to meaningful activity has been accomplished by 15 patients. This experience demonstrates that combined kidney and pancreas transplantation can be performed safely and successfully.

(Arch Surg. 1990;125:881-885)

Author Affiliations
From the Transplantation Service, University Hospitals of Cleveland (Drs Schulak, Mayes, and Hricik), and the Departments of Surgery (Drs Schulak and Mayes) and Medicine (Dr Hricik), Case Western Reserve University School of Medicine, Cleveland, Ohio.

Footnotes
Accepted for publication March 19, 1990.

Read before the 97th Annual Meeting of the Western Surgical Association, St Louis, Mo, November 15, 1989.

Reprint requests to Department of Surgery, University Hospitals of Cleveland, 2074 Abington Rd, Cleveland, OH 44106 (Dr Schulak).

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