BACKGROUND: The first simultaneous pancreas and kidney (SPK) transplant was performed in 1966. Early procedures were associated with significant morbidity and mortality and were performed in very low numbers in select patients. METHODS: This study includes all recipients of an SPK at the University of Wisconsin-Madison between 1986 and 1993, who were actively followed and had a functional pancreas allograft for >25 years as of October 31, 2018. RESULTS: A total of 291 SPK were performed during the study period; of these, 39 patients still had a functional graft at last follow up and 9 (18.8%) pancreas grafts were lost due to patient death or graft failure after >25 years. At last follow up, all 39 patients with functional pancreas graft had at least one comorbidity, such as hypertension, hyperlipidemia, or coronary artery disease. Twenty-seven required enteric conversion; 11 patients experienced renal allograft failure (10 underwent a repeat kidney transplant); and 6 required amputation of part of the lower extremity. In the Cox regression analysis, bladder drained pancreas was associated with lower probability of prolonged pancreas graft survival (hazard ratio: 0.52; confidence interval: 0.32-0.85; P = 0.01). CONCLUSIONS: With careful and detailed follow-up and attention to complications, some recipients of pancreas grafts have outstanding outcomes. As the number of pancreas recipients with prolonged graft survival may be rising, healthcare providers should be aware of the management of complications associated with this unique group of patients.
BACKGROUND: The first simultaneous pancreas and kidney (SPK) transplant was performed in 1966. Early procedures were associated with significant morbidity and mortality and were performed in very low numbers in select patients. METHODS: This study includes all recipients of an SPK at the University of Wisconsin-Madison between 1986 and 1993, who were actively followed and had a functional pancreas allograft for >25 years as of October 31, 2018. RESULTS: A total of 291 SPK were performed during the study period; of these, 39 patients still had a functional graft at last follow up and 9 (18.8%) pancreas grafts were lost due to patient death or graft failure after >25 years. At last follow up, all 39 patients with functional pancreas graft had at least one comorbidity, such as hypertension, hyperlipidemia, or coronary artery disease. Twenty-seven required enteric conversion; 11 patients experienced renal allograft failure (10 underwent a repeat kidney transplant); and 6 required amputation of part of the lower extremity. In the Cox regression analysis, bladder drained pancreas was associated with lower probability of prolonged pancreas graft survival (hazard ratio: 0.52; confidence interval: 0.32-0.85; P = 0.01). CONCLUSIONS: With careful and detailed follow-up and attention to complications, some recipients of pancreas grafts have outstanding outcomes. As the number of pancreas recipients with prolonged graft survival may be rising, healthcare providers should be aware of the management of complications associated with this unique group of patients.
Authors: Bryan N Becker; Jon S Odorico; Yolanda T Becker; Marilyn Groshek; Cathy Werwinski; John D Pirsch; Hans W Sollinger Journal: J Am Soc Nephrol Date: 2001-11 Impact factor: 10.121
Authors: H W Sollinger; T M Sasaki; A M D'Alessandro; S J Knechtle; J D Pirsch; M Kalayoglu; F O Belzer Journal: Surgery Date: 1992-10 Impact factor: 3.982
Authors: Herwig-Ulf Meier-Kriesche; Akinlolu O Ojo; Friedrich K Port; Julie A Arndorfer; Diane M Cibrik; Bruce Kaplan Journal: J Am Soc Nephrol Date: 2001-06 Impact factor: 10.121
Authors: H W Sollinger; E M Messing; D E Eckhoff; J D Pirsch; A M D'Alessandro; M Kalayoglu; S J Knechtle; D Hickey; F O Belzer Journal: Ann Surg Date: 1993-10 Impact factor: 12.969
Authors: Jonathan A Fridell; Silke Niederhaus; Michael Curry; Read Urban; Abigail Fox; Jon Odorico Journal: Am J Transplant Date: 2018-10-04 Impact factor: 8.086
Authors: Bertram L Kasiske; Shakeel Anjum; Rajiv Shah; Jeffrey Skogen; Chitra Kandaswamy; Barbara Danielson; Eileen A O'Shaughnessy; David C Dahl; John R Silkensen; Meena Sahadevan; Jon J Snyder Journal: Am J Kidney Dis Date: 2004-06 Impact factor: 8.860
Authors: Aleksandra Kukla; Pedro Ventura-Aguiar; Matthew Cooper; Eelco J P de Koning; David J Goodman; Paul R Johnson; Duck J Han; Didier A Mandelbrot; Martha Pavlakis; Frantisek Saudek; Marie-Christine Vantyghem; Titus Augustine; Michael R Rickels Journal: Am J Kidney Dis Date: 2021-05-14 Impact factor: 11.072