Complications after simultaneous pancreas and kidney transplantation and the impact of transplanted pancreas on kidney graft function in patients with diabetes mellitus type 1

Background: Simultaneous pancreas and kidney transplantation (SPK) is a method of choice in the therapy of patients with chronic renal failure secondary to diabetes mellitus type 1 (IDDM). However, higher incidence of complications is observed after SPK compared to kidney transplantation alone (KTA). The aim of the study was to analyze the risk of pancreas and kidney graft loss and patients death after SPK and KTA.
Material/Methods: 32 patients after SPK were analyzed. Control group consisted of 27 patients with IDDM, who underwent cadaveric KTA.
Results: In early postoperative period 4 patients lost pancreatic graft due to
thrombosis and 1 due to infection. Three of these patients lost also kidney  graft and eventually died due to bacterial and fungal infections. Ten patients (31.2%) required early re-laparotomies (bleeding - 6, pancreatic graft necrosis - 4, and others - 6).There was no primary kidney graft nonfunction (PGN) in SPK, while there were 3 PGN in KTA. During 5-years follow-up 2 patients died (1 in each group, 5-years probability of patients' survival 85% in SPK and 92% in KTA) and 4 lost their kidney grafts (2 in each group, 5-years probability o graft survival 94% in SPK and 89% in KTA). Kidney graft excretory function was slightly (NS) better in SPK.
Conclusions: SPK seems not to have a beneficial influence on kidney graft  function in up to 5 years observation.

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