Simultaneous pancreas-kidney transplantation with the pancreatico-duodeno-cystostomy technique. Technical aspects and preliminary results in 21 patients

Today pancreas transplantation is performed in patients with type I diabetes mellitus with end-stage renal failure accompanied by diabetic retinopathy and neuropathy. Aim of this paper is the description of the surgical procedure of pancreas harvesting and grafting using the pancreaticoduodeno-cystostomy technique, originally described by Gliedman and Sollinger, as well as a description of postoperative management and a short analysis of the results. From October 1988 to May 1991, 26 pancreatic transplants with bladder drainage technique have been performed at the Transplantation Centre of the Ludwig-Maximilians University of Munich. Five patients were grafted with a pancreas alone and 21 received a kidney and a pancreas simultaneously. In the analyzed group (n = 21), the actuarial survival rate for patients is 95.2%, for kidneys 75% and for pancreas 57.1%, by a follow-up period ranging from 1 to 28 months. A preliminary analysis, which compares the group of 26 grafts with bladder-drainage technique with a subgroup of 57 patients submitted to duct-occlusion technique (September 1984-September 1988), shows a reduction of the incidence of thromboses from 12.2% to 7.7%, of fistulae from 21% to 7.7% and of reinterventions from 47% to 30.7%. The urinary amylase and lipase monitoring showed to be useful for the diagnosis of pancreatic rejection. Improving of results in combined kidney-pancreas transplantation confirms the validity of this procedure for type I diabetic patients with late diabetic complications. The interruption of insulin therapy and possible slowing or stopping of diabetic retinopathy and neuropathy could improve the quality of life of these patients.