SP724SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANT: A SINGLE-CENTER 10 YEARS' EXPERIENCE

Abstract

INTRODUCTION AND AIMS: Simultaneous pancreas-kidney transplant (SPKT) has become the most effective treatment for patients with type 1 diabetes mellitus and endstage renal failure secondary to diabetic nephropathy. SPKT increases patient survival, enhances their quality of life and prevents or minimizes progression of diabetic complications. The aim of this study is to describe the cohort of patients who underwent SPKT at our center and follow up outcomes. METHODS: Retrospective analysis of 72 SPK transplants was performed from December 2007 to December 2017. Clinical and radiologic data were reviewed. RESULTS: Of the 72 SPK transplants, 6 were preemptive and 3 were performed after previous kidney graft failure. The mean age at the time of transplant was 37+/-7 years, with 46 being males and 26 females. The median duration of diabetes following diagnosis was 25.5 years. The mean of HbA1c before transplant was 8.7%. 42% of patients had coronary artery disease. Sixty-four patients had hypertension and thirty-one had smoking history. The mean duration of dialysis was 2.8 years. Donors had a mean age of 34 +/-8 years, and presented a mean serum of creatinine 0.8 mg/dL (range, 0.4-2mg/dL). The causes of donors' death were cerebrovascular accident in 42, trauma in 19, hypoxic brain damage in 8 and others in 3. Most patients (33.8%) received organs with 4 HLA mismatches. 14.7% of patients had a 6 mismatch transplant. The induction immunosuppressive regime for most patients (95.8%) consisted on the association of anti-lymphocyte globulin, tacrolimus, mycophenolate mofetil and steroids as induction. The median follow-up time of patients was 31 months. 4 patients died, mainly due to postoperative complications. Only one patient died due to late infection (disseminated tuberculosis) at 4 months. Pancreas failed in 13 patients, due to splenic venous thrombosis in 8 cases and to late acute rejection in one patient at 9 months. Median time survival of pancreatic graft was 24 months. Kidney graft failed in 7 patients, due to renal vein thrombosis (in 4 cases). No acute kidney rejection was observed in early posttransplant period. Median time survival of kidney graft was 28 months. Only one patient lost both grafts, due to venous thrombosis. The death-censored graft survival rates for pancreas were 80% at 1, 5 and 10 years and for kidney were 91% at 1, 5 and 10 years. The patient survival rates were 96% at 1, 5 and 10 years. CONCLUSIONS: SPKT is a multiple organ transplantation that involves major surgery and risks since early postoperative period, mainly thrombotic complication. Outcomes of our cohort are similar to those described in the literature. Currently, 94% of patients are alive, 95.6% have a functioning kidney, 86.7% have a functioning pancreas and 83.8% have both grafts functioning.