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Long-term outcomes after simultaneous pancreaskidney transplant

Wai, Philip Y; Sollinger, Hans W

Current Opinion in Organ Transplantation: February 2011 - Volume 16 - Issue 1 - p 128–134
doi: 10.1097/MOT.0b013e328341b0b5
Pancreas transplantation: Edited by Jose Figueiro
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Purpose of review Simultaneous pancreaskidney (SPK) transplantation represents the only proven long-term therapeutic approach for type 1 diabetic, dialysis-dependent patients. This procedure potentially liberates these patients from dialysis and the need for exogenous insulin replacement. For the first time, data on the long-term natural history of patients receiving SPK have recently been analyzed. In this review, we discuss the outcomes and complications for patients receiving SPK in the context of the current literature.

Recent findings In our analysis of 1000 SPKs performed at our center, we demonstrated that SPK increases patient survival compared with live-donor kidney alone or deceased donor kidney alone transplantation. The 5-year, 10-year, and 20-year patient survival for SPK recipients was 89, 80, and 58%, respectively. Enteric drainage improves quality of life, but not allograft survival, when compared with bladder drainage. After transplantation, approximately 50% of bladder-drained transplants undergo enteric conversion and late conversion after transplantation is associated with a higher complication rate. Surgical complications are higher in enteric-drained compared with bladder-drained pancreas transplants.

Summary Selecting the appropriate therapy for a type 1 diabetic recipient with renal failure continues to be a critical decision for programs offering pancreas transplantation. The principles and guidelines at our center are driven by the potential benefit of the SPK transplant needing to outweigh the increased morbidity of the surgical procedure and the use of lifelong immunosuppression. Results from long-term studies demonstrating improved patient survival suggest that the treatment of choice for an appropriate type 1 diabetic recipient is an SPK transplant.

University of Wisconsin, Madison, Wisconsin, USA

Correspondence to Hans W. Sollinger, MD, PhD, Folkert O. Belzer Professor of Surgery, Division of Transplantation, University of Wisconsin, 600 Highland Avenue, H4/780, CSC, Madison, WI 53792, USA Tel: +1 608 262 8360; e-mail: hans@surgery.wisc.edu

© 2011 Lippincott Williams & Wilkins, Inc.