Simultaneous Pancreas-Kidney Transplantation From Live Donors

Abstract

ObjectiveIn this first report of a clinical series of simultaneous pancreas-kidney transplants (SPKs) from live donors, the authors assess donor and recipient outcome as well as the spectrum of surgical and metabolic complications. Summary Background DataThe rationale for live (vs. cadaveric) donation includes an immunologic advantage (better matching, decreased drugs, and fewer rejection episodes) and elimination of waiting time. Only sequential kidney and pancreas or pancreas transplants alone from live donors had been done until the authors' current series. MethodsBetween March 15, 1994, and March 15, 1997, the authors performed 20 SPKs from live donors (6 human leukocyte antigen-identical siblings, 14 mismatched relatives [5 parents, 7 siblings, 1 daughter, 1 aunt]). Of the 20 donors, 13 were women, and 7 were men; median age was 43 years (range, 30-58 years). All donors underwent standardized metabolic workup, including oral glucose tolerance tests, determination of hemoglobin Al c levels, and tests to study insulin secretion and functional insulin secretory reserve. Of the 20 recipients, 12 were women, and 8 were men; median age was 34 years (range, 14-50 years). Management of exocrine pancreatic secretions was with bladder drainage in 17 and duct injection in 3 recipients. Median follow-up was 9 months (range, 1-36 months). ResultsCurrently, all 20 kidney grafts are functioning. Of the 20 pancreas grafts, 15 are functioning, 3 thrombosed, but 2 of those patients underwent immediate retransplantation from a cadaveric donor, and their grafts currently are functioning. Recipient complications included three anastomotic leaks and three intra-abdominal abscesses. Donor complications included four splenectomies, two peripancreatic fluid collections, one pseudocyst, and one intra-abdominal abscess; two donors underwent reoperation. Three donors had impaired glucose metabolism postdonation. Using tacrolimus and mycophenolate mofetil for mainstay immunosuppression, only 8 of 20 recipients experienced .1 rejection episode; only 1 pancreas graft was lost to rejection. Donor and recipient mortality was 0%. ConclusionSimultaneous pancreas-kidney transplants from live donors can be done with no mortality and good graft outcome. With stringent donor criteria, this approach could become 471

Adult human cytokeratin 19-positive cells reexpress insulin promoter factor 1 in vitro: further evidence for pluripotent pancreatic stem cells in humans.

“…Indeed, exocrine cells are easily obtained from human pancreases and may prove to be a particularly abundant source of ␤-cell precursors for allogenic cell therapy in type 1 diabetes. Furthermore, because partial pancreatectomy can be performed with little morbidity (47), this method may also allow the isolation of immunologically privileged cells obtained from living related donors. This abundant source of pancreatic stem cells could even offer a realistic perspective for autologous somatic cell therapy of type 1 diabetes (7).…”

Kidney, Pancreas and Islet Transplant Options for Patients with Diabetic Nephropathy

“…Recently, laparoscopic [19] and robotic surgery [20] have also been applied for pancreas transplantation with very encouraging results. Finally, partial pancreatic explant from living donors has been documented with excellent results in experienced transplant centers [16,[21][22][23][24][25].…”

“…Finally, the scarce of organs for transplantation has made feasible living related pancreas donation [23][24][25]. However, this policy has been restricted mainly to experienced transplant centers in the US, Europe and Japan.…”

“…Timely referral to a transplant center has been shown to increase transplant rates and decrease mortality [15]. Living related SPK from well selected donors remains an option but only for very experienced transplant centers around the world [16,[23][24][25]. Regarding KT, living transplant options (LDKT) should be extensively discussed with the diabetic candidate.…”

Pancreas Transplantation

“…Potential donors with a history of gestational diabetes are also excluded. 42,43 Initial pancreas specific laboratory screening tests include serum amylase and lipase, fasting plasma glucose, and fasting hemoglobin (Hb) AIC determination. Part of their extensive metabolic evaluation, potential donors undergo oral glucose tolerance tests and studies to determine their insulin secretion and functional insulin secretory reserve.…”