One Hundred Eleven Simultaneous Pancreas-Kidney Transplantations: 10-Year Experience from a Single Center in Portugal

From May 2000 to May 2010, we performed 111 simultaneous pancreas-kidney transplants (SPKT) from cadaveric donors, by using enteric drainage and systemic vascular anastomosis. In 26 cases they showed 6 HLA mismatches. Immunosuppression included antithymocyte globulin, tacrolimus, mycophenolate mofetil, and steroids. The patients' mean age was 34 ± 6 years, and mean time from diabetes diagnosis was 23 ± 6 years; 107 patients had been on dialysis for 32 ± 24 months, and 4 had a preemptive status. Acute rejection episodes were detected in 20 patients (18%): in 3 cases they affected both organs, in 9 only the kidney, and in 8 only the pancreas. The incidence of complications needing reoperation was 28.8%. They were mostly pancreas graft-related, including bleeding, thrombosis, and infection. In more recent years, after a slight modification of surgical technique, we noted a decreased rate of complications. Six patients died from: 2 from cardiovascular or cerebrovascular disease, 3 from infection, and 1 from an unknown cause. Pancreas graft loss occurred in 26 and kidney graft loss in 12 patients. Four patients underwent a second pancreas and 5 a second kidney graft. Patients with surviving grafts showed good function: serum creatinine, 1.09 ± 0.23 mg/dL; fasting blood glucose, 79.7 ± 9.8 mg/dL; and HbA1c, 4.88 ± 0.47%. Patient, kidney, and pancreas survival results were 96%, 96%, and 83% at 1; 94%, 91%, and 75% at 5; and 94%, 62%, and 69% at 10 years, respectively. These good results, compared with larger series and to recent pancreas transplant registry reports, are a strong motivation for the further development of this unique program in Portugal.