Simultaneous pancreas-kidney transplantation from live donors

Rainer W G Gruessner, David M. Kendall, Mary Beth Drangstveit, Angelika C Gruessner, David E R Sutherland

Research output: Contribution to journalArticle

94 Citations (Scopus)

Abstract

Objective: In this first report of a clinical series of simultaneous pancreas-kidney transplants (SPKs) from live donors, the authors assess donor and recipient outcome as well as the spectrum of surgical and metabolic complications. Summary Background Data: The rationale for live (vs. cadaveric) donation includes an immunologic advantage (better matching, decreased drugs, and fewer rejection episodes) and elimination of waiting time. Only sequential kidney and pancreas or pancreas transplants alone from live donors had been done until the authors' current series. Methods: Between March 15, 1994, and March 15, 1997, the authors performed 20 SPKs from live donors (6 human leukocyte antigen-identical siblings, 14 mismatched relatives [5 parents, 7 siblings, 1 daughter, 1 aunt]). Of the 20 donors, 13 were women, and 7 were men; median age was 43 years (range, 30-58 years). All donors underwent standardized metabolic workup, including oral glucose tolerance tests, determination of hemoglobin A1c levels, and tests to study insulin secretion and functional insulin secretory reserve. Of the 20 recipients, 12 were women, and 8 were men; median age was 34 years (range, 14-50 years). Management of exocrine pancreatic secretions was with bladder drainage in 17 and duct injection in 3 recipients. Median follow-up was 9 months (range, 1-36 months). Results: Currently, all 20 kidney grafts are functioning. Of the 20 pancreas grafts, 15 are functioning, 3 thrombosed, but 2 of those patients underwent immediate retransplantation from a cadaveric donor, and their grafts currently are functioning. Recipient complications included three anastomotic leaks and three intra-abdominal abscesses. Donor complications included four splenectomies, two peripancreatic fluid collections, one pseudocyst, and one intra-abdominal abscess; two donors underwent reoperation. Three donors had impaired glucose metabolism postdonation. Using tacrolimus and mycophenolate mofetil for mainstay immunosuppression, only 8 of 20 recipients experienced ≤1 rejection episode; only 1 pancreas graft was lost to rejection. Donor and recipient mortality was 0%. Conclusion: Simultaneous pancreas-kidney transplants from live donors can be done with no mortality and good graft outcome. With stringent donor criteria, this approach could become another surgical alternative for endocrine replacement therapy in selected patients with uremic type I diabetes.

Original languageEnglish (US)
Pages (from-to)471-482
Number of pages12
JournalAnnals of Surgery
Volume226
Issue number4
DOIs
StatePublished - 1997
Externally publishedYes

Fingerprint

Pancreas Transplantation
Kidney Transplantation
Tissue Donors
Transplants
Pancreas
Abdominal Abscess
Kidney
Siblings
Insulin
Mycophenolic Acid
Anastomotic Leak
Mortality
Tacrolimus
Splenectomy
Glucose Tolerance Test
HLA Antigens
Nuclear Family
Type 1 Diabetes Mellitus
Reoperation
Immunosuppression

ASJC Scopus subject areas

  • Surgery

Cite this

Simultaneous pancreas-kidney transplantation from live donors. / Gruessner, Rainer W G; Kendall, David M.; Drangstveit, Mary Beth; Gruessner, Angelika C; Sutherland, David E R.

In: Annals of Surgery, Vol. 226, No. 4, 1997, p. 471-482.

Research output: Contribution to journalArticle

Gruessner, Rainer W G ; Kendall, David M. ; Drangstveit, Mary Beth ; Gruessner, Angelika C ; Sutherland, David E R. / Simultaneous pancreas-kidney transplantation from live donors. In: Annals of Surgery. 1997 ; Vol. 226, No. 4. pp. 471-482.
@article{908da4b6917949d0b1df404cb3b7a895,
title = "Simultaneous pancreas-kidney transplantation from live donors",
abstract = "Objective: In this first report of a clinical series of simultaneous pancreas-kidney transplants (SPKs) from live donors, the authors assess donor and recipient outcome as well as the spectrum of surgical and metabolic complications. Summary Background Data: The rationale for live (vs. cadaveric) donation includes an immunologic advantage (better matching, decreased drugs, and fewer rejection episodes) and elimination of waiting time. Only sequential kidney and pancreas or pancreas transplants alone from live donors had been done until the authors' current series. Methods: Between March 15, 1994, and March 15, 1997, the authors performed 20 SPKs from live donors (6 human leukocyte antigen-identical siblings, 14 mismatched relatives [5 parents, 7 siblings, 1 daughter, 1 aunt]). Of the 20 donors, 13 were women, and 7 were men; median age was 43 years (range, 30-58 years). All donors underwent standardized metabolic workup, including oral glucose tolerance tests, determination of hemoglobin A1c levels, and tests to study insulin secretion and functional insulin secretory reserve. Of the 20 recipients, 12 were women, and 8 were men; median age was 34 years (range, 14-50 years). Management of exocrine pancreatic secretions was with bladder drainage in 17 and duct injection in 3 recipients. Median follow-up was 9 months (range, 1-36 months). Results: Currently, all 20 kidney grafts are functioning. Of the 20 pancreas grafts, 15 are functioning, 3 thrombosed, but 2 of those patients underwent immediate retransplantation from a cadaveric donor, and their grafts currently are functioning. Recipient complications included three anastomotic leaks and three intra-abdominal abscesses. Donor complications included four splenectomies, two peripancreatic fluid collections, one pseudocyst, and one intra-abdominal abscess; two donors underwent reoperation. Three donors had impaired glucose metabolism postdonation. Using tacrolimus and mycophenolate mofetil for mainstay immunosuppression, only 8 of 20 recipients experienced ≤1 rejection episode; only 1 pancreas graft was lost to rejection. Donor and recipient mortality was 0{\%}. Conclusion: Simultaneous pancreas-kidney transplants from live donors can be done with no mortality and good graft outcome. With stringent donor criteria, this approach could become another surgical alternative for endocrine replacement therapy in selected patients with uremic type I diabetes.",
author = "Gruessner, {Rainer W G} and Kendall, {David M.} and Drangstveit, {Mary Beth} and Gruessner, {Angelika C} and Sutherland, {David E R}",
year = "1997",
doi = "10.1097/00000658-199710000-00008",
language = "English (US)",
volume = "226",
pages = "471--482",
journal = "Annals of Surgery",
issn = "0003-4932",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - Simultaneous pancreas-kidney transplantation from live donors

AU - Gruessner, Rainer W G

AU - Kendall, David M.

AU - Drangstveit, Mary Beth

AU - Gruessner, Angelika C

AU - Sutherland, David E R

PY - 1997

Y1 - 1997

N2 - Objective: In this first report of a clinical series of simultaneous pancreas-kidney transplants (SPKs) from live donors, the authors assess donor and recipient outcome as well as the spectrum of surgical and metabolic complications. Summary Background Data: The rationale for live (vs. cadaveric) donation includes an immunologic advantage (better matching, decreased drugs, and fewer rejection episodes) and elimination of waiting time. Only sequential kidney and pancreas or pancreas transplants alone from live donors had been done until the authors' current series. Methods: Between March 15, 1994, and March 15, 1997, the authors performed 20 SPKs from live donors (6 human leukocyte antigen-identical siblings, 14 mismatched relatives [5 parents, 7 siblings, 1 daughter, 1 aunt]). Of the 20 donors, 13 were women, and 7 were men; median age was 43 years (range, 30-58 years). All donors underwent standardized metabolic workup, including oral glucose tolerance tests, determination of hemoglobin A1c levels, and tests to study insulin secretion and functional insulin secretory reserve. Of the 20 recipients, 12 were women, and 8 were men; median age was 34 years (range, 14-50 years). Management of exocrine pancreatic secretions was with bladder drainage in 17 and duct injection in 3 recipients. Median follow-up was 9 months (range, 1-36 months). Results: Currently, all 20 kidney grafts are functioning. Of the 20 pancreas grafts, 15 are functioning, 3 thrombosed, but 2 of those patients underwent immediate retransplantation from a cadaveric donor, and their grafts currently are functioning. Recipient complications included three anastomotic leaks and three intra-abdominal abscesses. Donor complications included four splenectomies, two peripancreatic fluid collections, one pseudocyst, and one intra-abdominal abscess; two donors underwent reoperation. Three donors had impaired glucose metabolism postdonation. Using tacrolimus and mycophenolate mofetil for mainstay immunosuppression, only 8 of 20 recipients experienced ≤1 rejection episode; only 1 pancreas graft was lost to rejection. Donor and recipient mortality was 0%. Conclusion: Simultaneous pancreas-kidney transplants from live donors can be done with no mortality and good graft outcome. With stringent donor criteria, this approach could become another surgical alternative for endocrine replacement therapy in selected patients with uremic type I diabetes.

AB - Objective: In this first report of a clinical series of simultaneous pancreas-kidney transplants (SPKs) from live donors, the authors assess donor and recipient outcome as well as the spectrum of surgical and metabolic complications. Summary Background Data: The rationale for live (vs. cadaveric) donation includes an immunologic advantage (better matching, decreased drugs, and fewer rejection episodes) and elimination of waiting time. Only sequential kidney and pancreas or pancreas transplants alone from live donors had been done until the authors' current series. Methods: Between March 15, 1994, and March 15, 1997, the authors performed 20 SPKs from live donors (6 human leukocyte antigen-identical siblings, 14 mismatched relatives [5 parents, 7 siblings, 1 daughter, 1 aunt]). Of the 20 donors, 13 were women, and 7 were men; median age was 43 years (range, 30-58 years). All donors underwent standardized metabolic workup, including oral glucose tolerance tests, determination of hemoglobin A1c levels, and tests to study insulin secretion and functional insulin secretory reserve. Of the 20 recipients, 12 were women, and 8 were men; median age was 34 years (range, 14-50 years). Management of exocrine pancreatic secretions was with bladder drainage in 17 and duct injection in 3 recipients. Median follow-up was 9 months (range, 1-36 months). Results: Currently, all 20 kidney grafts are functioning. Of the 20 pancreas grafts, 15 are functioning, 3 thrombosed, but 2 of those patients underwent immediate retransplantation from a cadaveric donor, and their grafts currently are functioning. Recipient complications included three anastomotic leaks and three intra-abdominal abscesses. Donor complications included four splenectomies, two peripancreatic fluid collections, one pseudocyst, and one intra-abdominal abscess; two donors underwent reoperation. Three donors had impaired glucose metabolism postdonation. Using tacrolimus and mycophenolate mofetil for mainstay immunosuppression, only 8 of 20 recipients experienced ≤1 rejection episode; only 1 pancreas graft was lost to rejection. Donor and recipient mortality was 0%. Conclusion: Simultaneous pancreas-kidney transplants from live donors can be done with no mortality and good graft outcome. With stringent donor criteria, this approach could become another surgical alternative for endocrine replacement therapy in selected patients with uremic type I diabetes.

UR - http://www.scopus.com/inward/record.url?scp=0031473835&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0031473835&partnerID=8YFLogxK

U2 - 10.1097/00000658-199710000-00008

DO - 10.1097/00000658-199710000-00008

M3 - Article

C2 - 9351715

AN - SCOPUS:0031473835

VL - 226

SP - 471

EP - 482

JO - Annals of Surgery

JF - Annals of Surgery

SN - 0003-4932

IS - 4

ER -