Simultaneous kidney-pancreas (SKP) or pancreas after kidney (PAK) transplantation is treatment of choice for selected patients with type 1 diabetes mellitus and end-stage renal failure. However, it is difficult to start a program for the fear of serious intraabdominal complications in an immunosuppressed patient. We reviewed the first five patients who underwent SKP in Shiraz organ transplant center.
Methods: For the first time in Iran, between April 2006 and August 2006, we began performing SKP transplantation on 5 recipients. The operation included portal venous drainage and exocrine enteric drainage. Immunosuppressive therapy included prednisolone, tacrolimus, and mycophenolate mofetil and gancyclovir was administered as prophylaxis for cytomegalovirus. One case developed acute isolated pancreatic rejection and was excluded from study.
Results: The mean follow up was 92.6+/- 17.29 days (range, 63-107). Mean age of donors and recipients were 24+/-3.08 and 32.2 +/- 7.26 years, respectively. Male/female ratio was 1.5 for recipients. Duration of hospital admission was 15.8+/- 7.26 days (range, 8-27). Mean cold ischemic time was 5.55 +/- 3.21 hours. Mean pre-transplant NPH insulin consumption was 29.75 +/- 7.32 IU, on which, the mean serum glucose was 146.4 +/- 44.17 mg/dl. Subjects discontinue NPH, after transplantation. Serum glucose on the day of discharge decreased to 85 +/-7.07 mg/dl (P<0.05). Furthermore, post-transplant serum creatinine and BUN levels were 1.24 +/- 0.19 and 24.6 +/-6.84 mg/dl, respectively, which were considerably lower than their pre-transplant values (6.14 +/- 3.4 and 44.6 +/- 12.18 mg/dl; P<0.05). One case developed acute isolated pancreatic rejection 3 days after transplantation, resulting in pancreatic removal. Good patient and graft survival in short term and in these small series appreciated us to continue the program with all its difficulties. More experience is resulting in better patient’s selection, operation and survival rate.