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Over 9 years, we have performed 93 simultaneous pancreas-kidney transplants (SPKT). The morbidity of this procedure is high compared with kidney transplantation alone; readmissions are frequent and costs are higher. Herein we have presented the complications during follow-up of these 93 patients. Their mean age was 34 Ϯ 6 years and prior dialysis time was 32 Ϯ 25 months. The median hospital stay on the first admission for the transplant procedure was 22 days, including 2 days in the intensive care unit. Bleeding, thrombosis, and infection were the most frequent reasons for prolonged hospitalization. Thirty patients underwent Ն1 surgical reinterventions. Incidence of acute rejection episodes was 11.8%. After discharge, 74.2% of the patients had 197 readmission episodes with infection being the main cause, urinary tract infections, the most frequent; however, systemic viral and fungal infections required the longest readmission periods. The need for surgical interventions, graft dysfunction, and vascular problems were the remaining causes of readmission. At the end of follow-up, 87 patients were alive, 86 with well-functioning kidneys and 74 with normal functioning pancreata. Global survival rates for patient, kidney, and pancreas were 96%, 95%, and 81% at 1-year; 93%, 90%, and 79% at 5-years; and 93%, 90% and 79% at 9-years. Although pancreas-kidney transplant patients are complex presenting many management difficulties, our overall results represent a positive stimulus for diabetic patients. S imultaneous pancreas-kidney transplantation (SPKT)display greater morbidity, length of admission, and number of complications when compared to kidney transplantation alone (KTA), leading to higher costs. However, SPKT remains the best treatment option for good longterm results among type 1 diabetic patients with chronic kidney failure. A recently published review of 1000 SPKT from a single center 1 reinforced this position statement of the American Diabetes Association. We have presented herein the results of our SPKT program, including the rate and type of complications, causes of surgical reinterventions, and readmission episodes after the initial discharge. PATIENTS AND METHODSFrom May 2000 to May 2009, we performed 93 SPKT always using enteric diversion and vascular anastomoses to the systemic circulation. Immunosuppression included antithymocyte globulin (ATG) tacrolimus, mycophenolate mofetil (MMF), and steroids. After the 6th month, it was our policy to progressively taper steroids to complete withdrawal whenever possible. Infection prophylaxis comprised vancomycin, fluconazole, and a third-generation cephalosporin in the first days, with contrimoxazole and valgancyclovir thereafter. We also prescribed aspirin and low-molecularweight heparin as soon as possible after surgery, if there were no bleeding complications. RESULTSThe mean age of the 93 patients was 34 Ϯ 6 years with a 23 Ϯ 5.5 years, duration of diabetes. They had been on dialysis for 32 Ϯ 25 months excepting 4 who were grafted preemptively. Twenty...

Background: A well-functioning vascular access is vital to patients on regular hemodialysis. Banding the access is indicated in high-flow-associated steal syndrome. It allows for the reduction of access flow while maintaining distal limb perfusion. Nonetheless, this procedure has some limitations as it can cause hemorrhage, infection, aneurysm formation, thrombosis of access in cases of overbanding, or otherwise insufficient reduction of vascular flow. Other surgical techniques to achieve the same benefit would be useful. Methods: We performed a modified banding technique without endovascular placement of the angioplasty balloon, which is a viable alternative to other techniques. This surgery was performed in patients on chronic dialysis with steal syndrome. Pre- and post-operative access flows were measured and resolution of symptoms was recorded. Primary patency rate was defined as the intervention-free access survival from the operative time. Results: We verified that this technique allowed for access flow reduction in all our six patients, with total resolution of symptoms in all patients. Primary patency rate at 12 months was 100%. No major complications were noted during our follow-up. Conclusions: This technique allows for correction of high-flow arteriovenous fistulas in an efficient and safe way, and can be a viable alternative to other banding procedures.

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