Technology and application of simultaneous pancreas-kidney transplantation with modified enteric drainage

Objective To report the modified technique and the short-term results of simultaneous pancreas-kidney transplantation(SPK)with the entetic drainage(ED)of exocrine secretions.Methods From June 2000 to August 2006,thirty-eight patients with diabetes complicated with uremia underwent SPK.The pancreas graft was placed intraperitoneally with exocrine secretions drained into the proximal jejunum without Roux-en-Y procedure.The mean cold ischemic times of pancreas and kidney were(10±2.0)h and(7± 2.0)h,respectively.Quadruple immunosuppressive therapy with antilymphocyte globulin or anti-CD25 monoclonal antibody,taerolimus,mycophenolate mofetil and steroids was adopted except one patient.Results The 6-month survival rates of patients and grafts were both 97.4% after transplantation.All patients achieved insulin-free euglycemia at(7±6.9)d postoperative except one.For preoperative patients,mean fasting insulin and C-peptide values were(9±8.1)mU/L and(6±4.5)mU/L.After operation,fasting insulin and C-peptide values of patients were(12±5.8)mU/L and(6±4.7)mU/L,respectively,which peaked to an insulin level of(57±43.0)mU/L and a C-peptide level of(11±6.8)mU/L with stimulation.There were eight cases of delayed renal graft function.All other patients achieved immediate renal graft function.No graft losses occurred due to leakage or intra-abdominal infection.The most common surgical complications were wound infection(n=12),enteric anastomostic hemorrage(n=5)and perirenal hemorrage(n=2).Three patients(7.9%)had been reoperated for the reasons of intra-abdominal hemorrhage and perirenal hemorrhage.Conclusions SPK is an effective treatment option for selected patients with diabetes mellitus and approaching end-stage renal disease.Enteric exocrine drainage by direct side-to-side anastomosis(without Roux-en-Y)seems to be a simple and reliable technique.