Combined kidney and pancreas transplantation. A safe and effective treatment for diabetic nephropathy
J. A. Schulak, J. T. Mayes and D. E. Hricik
Transplantation Service, University Hospitals of Cleveland, OH 44106.
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 reoperation, 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.
