Surgical site and early urinary tract infections in 1000 kidney transplants with antimicrobial perioperative prophylaxis.

Surgical site infections (SSIs) and early urinary tract infections (UTIs) are well recognized postoperative kidney transplant complications. These complications seldom lead to graft loss, although they may result in significant morbidity with prolonged hospitalization. Thus, perioperative antibiotic prophylaxis (PAP) has traditionally been used in this setting. Between April 1988 and December 2012, we identified 1000 kidney transplant recipients (33 from living donors) who underwent prophylaxis with ceftriaxone before the surgical procedure. A retrospective analysis was conducted to evaluate both the incidence rate and outcome of SSIs and UTIs. Recipients who developed SSIs were also assessed to identify risk factors and potential correlations with different immunosuppressive regimens. A total of 20 SSIs (2%) and 93 UTIs (9.3%) were observed. The most significant risk factor for SSIs was urine leak (15.38%; odds ratio [OR], 12.3; P < .0001) followed by sirolimus-based maintenance immunosuppression therapy (5%; OR, 2.97; P = .04) and induction therapy with either antithymocyte globulin or basiliximab (3.18%; OR, 3.45; P = .01). Sex was identified as the only risk factor for UTI (female vs male, 17.1% vs 4.6%; P < .0001). We believe universal ceftriaxone-based prophylaxis is useful for preventing SSIs and UTIs, considering its effectiveness and safety profile.

Percutaneous ultrasound-guided radiofrequency ablation of an allograft renal cell carcinoma: a case report.

BACKGROUND: Renal cell carcinomas (RCCs) are rarely described in transplanted kidneys. Available therapeutic strategies range from allograft nephrectomy to nephron-sparing procedures such as partial nephrectomy or image-guided thermal ablation. Percutaneous radiofrequency ablation (RFA) is a minimally invasive technique which provides promising oncologic outcomes in small allograft RCCs while preserving allograft function. So far, only a few cases have been reported in the transplant setting. We describe a renal transplant RCC successfully approached by ultrasound-guided RFA. METHODS: A 42-year-old renal transplant recipient developed a small subcapsular allograft RCC at 11 years after transplantation. The decline in glomerular filtration rare prompted us to preserve as much parenchyma as possible. Ultrasound-guided RFA was performed under light sedation and local analgesia in a single session with a Starbust Talon needle. RESULTS: Postablation contrast-enhanced ultrasound displayed a 25×23 mm avascular area of complete necrosis. After 3 months gadolinium-enhanced magnetic resonance imaging confirmed the absence of viable tumor tissue and while the patient did not experience any graft function reduction (serum creatinine 2.6 mg/dL). CONCLUSIONS: Image-guided RFA represents a promising therapeutic modality for small allograft RCCs in recipients with mild graft dysfunction and/or elevated surgical risk. It is associated with low morbidity and parenchymal preservation.

Embolization of pancreatic allograft arteriovenous fistula with the Amplatzer Vascular Plug 4: case report and literature analysis.

Vascular complications remain a major cause of graft loss after pancreatic transplantation. They include vascular thrombosis, pseudoaneurysm, and arteriovenous fistula (AVF). We report a case of an AVF that appeared 3 months after a simultaneous pancreas-kidney transplantation (SPKT). Doppler ultrasonography followed by magnetic resonance angiography and later angiography provided a definitive diagnosis of a mesenteric AVF. An endovascular approach is becoming the treatment of choice owing to the high risk of graft loss associated with open surgical correction. Microcoils alone, or in conjunction with detachable balloons, are frequently used; still, a new generation of vascular plugs seem to offer a therapeutic option for AVF closure, because it is a "1 shot" procedure that avoids the risk of accidental coil migration. A new-generation Amplatzer Vascular Plug 4 was deployed over the distal arterial branch of the superior mesenteric artery stump, leading to complete exclusion of the AVF and restoring normal vascular flow.

Analysis of 80 dual-kidney transplantations: a multicenter experience.

INTRODUCTION: The use of kidneys from expanded criteria donors (ECD) is an attractive strategy to enlarge the pool of organs available for transplantation. Considering the fact that ECD organs have a reduced nephron mass, they are preferentially allocated for dual-kidney transplantation (DKT). Authors have reported excellent results of DKT when pretransplant ECD organs are evaluated for histological scores. The aim of this study was to evaluate DKT donor and recipient characteristics for comparison with DKT posttransplant outcomes versus those of recipients of single-kidney transplantations from expanded criteria (edSKT) and ideal donors (idSKT). We analyzed the potential prognostic factors involved in DKT among a population derived from three transplant centers. MATERIALS AND METHODS: Between 2001 and 2007, DKT (n = 80) were performed based upon the ECD kidney allocation assessed by biopsy. RESULTS: The average donor ages for the DKT, edSKT, and idSKT groups were 68.8 ± 7.8, 65.3 ± 7.2, and 40.1 ± 13.8 years, respectively (P < .001). The number of human leukocyte antigen mismatches was greater in the DKT group (3.1 ± 1.2, P < .05). Patient and graft 5-year survival rates were similar among DKT, edSKT, and idSKT recipients, namely, 97.5% versus 95.8% versus 96.9% and 93.7% versus 87.4% versus 86.9%, respectively. Mean serum creatinine values at discharge were lower in the DKT and idSKT recipients (1.5 ± 0.9 and 1.6 ± 0.7 mg/dL; P < .05) compared with the edSKT group (1.9 ± 0.7 mg/dL). Correlations between supposed prognostic factors and survival among the DKT group noted worse outcomes in reoperation cases (P < .05). CONCLUSION: We confirmed that DKT produced successful outcomes. An accurate surgical procedure is particularly important to try to avoid reoperations. In our experience, the use of a biopsy as an absolute criterion to allocate ECD kidneys may be too protective.

Total duodenectomy with enteric duct drainage: a rescue operation for duodenal complications occurring after pancreas transplantation.

Duodenal graft complications (DGC) occur frequently after pancreas transplantation but rarely cause graft loss. Graft pancreatectomy, however, may be required when DGC compromise recipient's safety. We herein report on two patients with otherwise untreatable DGC in whom the entire pancreas was salvaged by means of total duodenectomy with enteric drainage of both pancreatic ducts. The first patient developed recurrent episodes of enteric bleeding, requiring hospitalization and blood transfusions, starting 21 months after transplantation. The disease causing hemorrhage could not be defined, despite extensive investigations, but the donor duodenum was eventually identified as the site of bleeding. The second patient was referred to us with a duodenal stump leak, 5 months after transplantation. Two previous surgeries had failed to seal the leak, despite opening a diverting stoma above the duodenal graft. Thirty-nine and 16 months after total duodenectomy with dual duct drainage, respectively, both patients are insulin-independent and free from abdominal complaints. Magnetic resonance pancreatography shows normal ducts both basal and after intravenous injection of secretin. The two cases presented herein show that when DGC jeopardize pancreas function or recipient safety, total duodenectomy with enteric duct drainage may become an option.

[Living donor nephrectomy: open versus laparoscopic technique].

The living donor nephrectomy has to be safe and effective, allowing a good graft function in the recipient. In the past, donor nephrectomy was performed only by open technique; more recently this nephrectomy has also been performed by laparoscopic technique. The best technique has not been established in literature. The purpose of this study is to report the results of open and laparoscopic nephrectomy in living donors. MATERIALS AND METHODS. From January 1992 to August 2008, 37 living donor nephrectomies were performed. 23 nephrectomies were achieved by laparoscopic procedure (LDN) and 14 by open technique (ODN). The 2 groups were comparable regarding both donor and recipient characteristics. RESULTS. All laparoscopic nephrectomies were successfully performed without conversion to open procedure. No donor deaths were reported in either groups. 3 complications (13%) in the LDN group and 1 (7.1%) in the ODN group (p=0.6) were observed. Mean operative time was higher in the LDN group (p<0.036). Mean warm and cold ischemia time, resumption of oral intake and hospital stay were shorter in the LDN group (p<0.04)( p<0.03) (p<0.0001), whereas the return to normal occupational life was similar (p<0.52). We had no significant differences in the surgical complication rates, graft and patient survival. CONCLUSIONS. Our experience suggests that both procedures can be used safely and efficiently, and assure a good renal function in the recipient. Laparoscopic nephrectomy, although more difficult, provides post-operative advantages. However, laparoscopic procedure must be performed by experienced centres only to prevent serious complications in the donor.

Multicenter study on double kidney transplantation.

BACKGROUND: Marginal organs not suitable for single kidney transplantation are considered for double kidney transplantation (DKT). Herein we have reviewed short and long-term outcomes of DKT over a 7-year experience. PATIENTS AND METHODS: Between 2001 and 2007, 80 DKT were performed in the transplant centers of Bologna, Parma, and Modena, Italy. Recipient mean age was 61+/-5 years. The main indications were glomerular nephropathy (n=33) and hypertensive nephroangiosclerosis (n=14). Mean HLA A, B, and DR mismatches were 3.1+/-1.2. Donor mean age was 69+/-8 years and mean creatinine clearance was 75+/-27 mL/min. Almost all kidneys were perfused with Celsior solution. Mean cold ischemia time was 17+/-4 hours and mean warm ischemia time was 41+/-17 minutes. Mean biopsy score was 4.4. Immunosuppression was based on tacrolimus (n=52) or cyclosporine (n=26). RESULTS: Fifty (62.5%) patients displayed good postoperative renal function. Thirty (37.5%) experienced acute tubular necrosis and required postoperative dialysis treatment; 8 acute rejections occurred. Urinary complications were 13.7% with 8/11 requiring surgical revision. There were 6 surgical reexplorations: intestinal perforation (n=2), bleeding (n=3), and lymphocele (n=1). Two patients lost both grafts due to vascular and infectious complications at 7 or 58 days after transplantation. Two patients underwent intraoperative transplantectomy due to massive vascular thrombosis. Four (5%) patients underwent transplantectomy of a single graft due to vascular complications (n=2), bleeding (n=1), or infectious complications (n=1). Graft and patient survivals were 95% and 100% versus 93% and 97% at 3 versus 36 months, respectively. CONCLUSIONS: DKT is a safe approach for organ shortage. The score used in this study is useful to determine whether a kidney should be refused or accepted.

[Endourological management of ureteral stenosis and vesicoureteral reflux after renal transplantation].

INTRODUCTION AND OBJECTIVES. Ureteral stenosis and vesicocoureteral reflux after renal transplantation represent a key concern because of their incidence and the associated morbidity. Prompt diagnosis and minimally invasive treatment are mandatory in immunosuppressed patients with single kidney. The aim of this study is to evaluate the success rate of the endourological techniques in the management of such complications. MATERIALS AND METHODS. Between January 1996 and December 2006, 647 kidney transplants were performed. Urinary tract continuity was re-established by ureteroneocystostomy according to Gregoir-Lich technique. We observed 13 cases of ureteral stenosis (2%) and 11 cases of symptomatic vesicoureteric reflux (1.7%). The endourogical procedure was performed in 13 patients: 5 cases of II-III grade vesicoureteric reflux, 4 early ureteral stenosis and 4 late ureteral stenosis. Patients with vesicoureteric reflux underwent endoscopic injection of macroplastique in 4 cases and Durasphere in 1. Early ureteral stenoses were treated using balloon dilation in 2 cases, balloon dilation and laser endoureterotomy in 3, ureteral stent placement in the other. Recipients with late stenosis underwent laser incision and balloon dilation in 2 cases, balloon dilation in 1 and a laser incision only in the last case. Combined antegrade and retrograde endoscopic approach was performed in 7 patients, whereas retrograde access in 1. RESULTS. Endourologic treatment was successful in 9 cases (69.2%); 2 patients required open reconstructive surgery due to endourological technique failure (early ureteropelvic junction stricture, late ureterovesical anastomotic stricture). Vesicoureteric reflux was corrected in 3 patients (60%), 2 patients underwent uretero-ureterostomy for recurrent reflux. No technique-related morbidity was observed. With a mean follow- up of 81.6 months, 8 patients show normal renal function, 5 patients have returned to haemodialysis (4 for chronic rejection, 1 for carcinoma in the graft). CONCLUSIONS. Considering their low morbidity and the satisfactory success rate, we claim that endourological procedures should be considered the preferred treatment for ureteral stenosis and vesicoureteric reflux in selected patients.

[Ligation of the native ureter in kidney transplant].

The urinary tract reconstruction in renal transplantation is usually performed by a ureterocystoneostomy according to Gregoire-Lich technique. In selected patients, native ureteral ligation with nephrectomy was done when end-to-end anastomosis for ureteroureterostomy was performed. Recently, some Authors have proposed the ligation of the native ureter without nephrectomy. We report our experience in the ligation of the native ureter with no associated nephrectomy. MATERIALS AND METHODS. In 978 renal transplantations performed from April 1986 through December 2006, we evaluated 68 recipients (69.5%) who underwent ureteral ligation without nephrectomy. Mean diuresis was 314 cc/day (range 0-1200 cc/day). Follow-up was 1 to 187 months. RESULTS. Only one patient (1.5%) required native nephrectomy for fever and abdominal pain. None of the other patients showed infections involving native kidney or flank pain during the follow-up. DISCUSSION AND CONCLUSION. Our experience confirms the safety and feasibility of native ureter ligation without omolateral nephrectomy. Nephrectomy is indicated in the case of coexistent intrinsic renal disease, such as non-treatable nephrovascular hypertension, symptomatic polycystic kidney disease, chronic renal infection.

Laparoscopic donor nephrectomy: short learning curve.

INTRODUCTION: The learning curve of laparoscopic donor nephrectomy (LDN) may represent a great technical challenge at centers with low volume of living donors. The number of LDNs required to overcome the learning curve is still unclear. Here we report the modality of approach to LDN at a low-volume living donor transplant center. MATERIALS AND METHODS: We reviewed the records of two groups of donors operated by two different surgeons between January 2002 and October 2005. We compared donor hospital stay, operative time, presence of multiple renal arteries, blood loss, operative details, and complications. RESULTS: The first six operations (group A) were performed by a well-trained laparoscopic surgeon (A.P.) with a consolidated experience in the LDN procedure, attended by our training surgeon (R.D.V.) who conducted the other six cases (group B). No conversion to an open procedure was necessary and there were no major minor complications. Mean operative time was 267.5 (+/-55.9) minutes in group A and 300 (+/-43.4) minutes in group B (P = .28). Mean warm ischemia time was 125 (+/-61.6) seconds in group A and 189.2 (+/-18.6) seconds in group B (P = .035). Mean hospital stay was 5.3 days in group A and 5.6 days in group B. CONCLUSIONS: LDN can be performed safely and efficiently in transplant centers with initial experience. A collaborative approach to this difficult procedure with a surgeon skilled in donor nephrectomy minimizes the risk to the donor and reduces the learning curve.

Octreotide in the treatment of lymphorrhea after renal transplantation: a preliminary experience.

BACKGROUND: Lymphorrhea is a minor complication after kidney transplantation but may develop into a lymphocele and prolong hospital stay. Treatment is conservative based on percutaneous drainage until lymphatic leakage cessation. It has been reported that octreotide has beneficial effects to treat lymphorrhea after axillary node dissection and excision of lymphatic malformations. The aim of this study was to report preliminary experience about octreotide treatment in lymphorrea after kidney transplantation. MATERIALS AND METHODS: This retrospective study included 20 recipients of cadaveric kidney allografts with posttransplant lymphorrhea including 10 treated with instillation of povidone iodate solution, and the other 10 with octreotide (0.1 mg three times a day subcutaneously). We reviewed the daily amount of fluid collection, duration of lymphorrhea, complications, lymphocele formation, rejection episodes, graft outcomes, and hospital stay. RESULTS: The average duration of lymphorrhea was 8.5 (+/-4.5) and 16.3 (+/-7.3) days for the octreotide versus the povidone groups, respectively (P = .001). No complications occurred among the octreotide group, while three lymphoceles grew among patients treated with povidone solution. No differences were observed for acute rejection episodes or renal function between the groups. No octreotide-related adverse events were noted. CONCLUSION: The mean length of lymphorrhea was lower with octreotide versus iodate povidone solution treatment. There was a shorter hospital stay and minor patient discomfort. In conclusion, lymphatic leakage after kidney transplantation may be successfully managed by octreotide administration.

Kidney transplantation from elderly donors: a prospective randomized study comparing celsior and UW solutions.

AIM: The aim of present study was to assess the effect of Celsior as compared with University of Wisconsin (UW) solution on immediate and long-term function of kidney transplants harvested from elderly donors. METHODS: A prospective multicenter randomized study was designed to evaluate the efficacy of Celsior versus UW solution for the clinical preservation of the kidney. Fifty renal transplants were performed from donors over 60 years old. Twenty-five kidneys were stored in Celsior and 25 in UW solution. The groups were comparable with regard to donor and recipient characteristics. Renal function outcomes were compared by evaluating delayed graft function rates, daily urinary output, as well as the evolution of mean serum creatinine at 1, 3, 5, 7, and 15 days. RESULTS: The warm ischemia time was 42.4 +/- 11 minutes among Celsior vs 46.9 +/- 17.9 minutes in the UW cohort (P = NS). The cold ischemia time was 18 +/- 4.5 hours in Celsior and 19 +/- 6.5 hours in UW (P = NS). Delayed graft function occurred in 48% of the Celsior group and in 52% of the UW group (P = NS). Mean serum creatinine levels and mean daily urinary output were also similar. One- and 5-year graft survivals of kidneys preserved with Celsior were 91.8% and 79.3% compared with 96% and 87.4% for UW without any significant statistical difference. CONCLUSIONS: Our data show that the preservation of kidneys from elderly donors in Celsior solution is equivalent to that of UW solution.

Acute diverticulitis with colon perforation in renal transplantation.

INTRODUCTION: Acute diverticulitis with colon perforation is a serious condition in transplant recipients. The aim of this study was to analyze our experience with colon perforations among 875 renal transplant recipients between January 1986 and September 2004. METHODS: Patients were analyzed by age, gender, steroid dosage, time interval from the transplantation, delay between symptoms and surgery, clinical presentation, surgical procedure, graft and patient outcomes. RESULTS: We identified 8 patients with colon perforation. The incidence of perforation was 0.9%. Mean age at the the time of perforation was 58.5 years. Fever, abdominal pain, localized or diffuse signs of peritonitis, and leukocytosis were present in 7 patients (87.5%). Three patients (37.5%) were on steroid-free immunosuppression, whereas in 2 cases (25%) the steroid dosage was >20 mg/d. The mean interval between transplantation and perforation was 4.1 years. Two episodes (25%) occurred within 1 month following transplantation and the other 6 (75%) between 1 and 15 years. The interval between the onset of symptoms and surgery was longer than 48 hours in 1 patient (12.5%). In 5 cases (62.5%), a Hartmann procedure was performed; in 2 patients (25%), a resection with primary anastomosis was preferred. The last patient had a direct suture of the colon. Mortality rate was 12.5%. At a median follow-up of 6.1 years, 6 patients (75%) are alive with 5 functioning grafts. CONCLUSIONS: Colon perforations in renal transplant recipients remain a challenging surgical problem. An aggressive diagnostic attitude and an immediate surgical treatment may contribute to significantly decrease the incidence and the mortality of this complication.

Percutaneous renal artery embolization of nonfunctioning allograft: preliminary experience.

Percutaneous renal artery embolization has been introduced as an alternative to nephrectomy for patients with a nonfunctioning allograft and Graft Intolerance Syndrome. The symptoms resulting from this syndrome include fever, local pain, hypertension, and hematuria. From April 2003 to October 2003, 5 patients were treated with this technique. The intraparenchymal renal arteries were embolized by injection of calibrated tris-acryl gelatin microspheres of increasing size (from 100-330 to 700-900 microm) and completed with the insertion of 5-mm-8-mm steel coils in the renal artery. The procedure was well tolerated in all cases; no major complications occurred. In 3 patients, the symptoms disappeared immediately. In 1 patient, it was necessary to perform a second embolization due to collateral circulation developing from a lumbar artery; this further procedure resolved the symptoms. In the last case, the patient underwent nephrectomy because of septic fever. In conclusion, patients with this syndrome refractory to medical treatment may be treated by the effective and minimally invasive procedures of percutaneous allograft artery embolization with no significant short-term or late complications.

The role of cholecystectomy in renal transplantation.

INTRODUCTION: We reviewed our clinical experience to assess the role of cholecystectomy transplant candidates pre- and posttransplantation. METHODS: Between April 1986 and December 2003, 57 (6.8%) candidates among 839 kidney transplants were found during routine pretransplant screening to show gallstones. RESULTS: Thirty nine (68.4%) symptomatic patients underwent cholecystectomy before transplantation. Among 18 (31.6%) asymptomatic patients monitored after transplantation, the 7 (39%) who developed biliary tract symptoms underwent laparoscopy or minilaparocholecystectomy without postoperative morbidity, mortality, or graft loss. CONCLUSIONS: Symptomatic gallstones have to be treated using the laparoscopic cholecystectomy or minilaparotomy technique. In asymptomatic cholelithiasis prophylactic cholecystectomy is only reserved for patients with biliary "intrinsic" risk factors. An early diagnosis and prompt surgical treatment yields good results.

Embolization of a ruptured pseudoaneurysm with massive hemorrhage following pancreas transplantation: a case report.

Pseudoaneurysm associated with an arterioenteric fistula is rare, but its clinical manifestations may represent a dramatic event that involves diagnostic and therapeutic problems. We report a case of an arterioduodenal fistula related to a ruptured pseudoaneurysm after simultaneous pancreas-kidney transplantation (SPK) with massive gastrointestinal hemorrhage treated by embolization of the Y graft. A 51-year-old man with type I diabetes and end-stage renal disease underwent SPK. No rejection episodes were documented; the patient was discharged with normal pancreatic and renal function. Two months later the patient was readmitted for an episode of massive lower digestive bleeding and hypotension. The Y-graft was embolized in order to obtain a prompt arrest of the bleeding. The procedure was successful and the patient progressively recovered. Once the hypovolemia was completely corrected, the graft was removed. An arterioenteric fistula between donor mesenteric artery and duodenum was confirmed. Few reports exist in the literature regarding the development of a pseudoaneurysm after pancreas transplantation. To our best knowledge only one case of pseudoaneurysm rupture into donor duodenum has been recently published. In our case angiography recognized the site of the pseudoaneurysm and its rupture into donor duodenum. Embolization of the Y-graft appeared the most rapid, simple, and safe approach to obtain the prompt arrest of the massive bleeding. Embolization of the Y-graft may represent a valid option in the presence of life-threatening hemorrhage.

University of Wisconsin solution versus Celsior solution in clinical pancreas transplantation.

INTRODUCTION: This study compared the safety and efficacy of University of Wisconsin solution (UW) and Celsior solution (C) in pancreas transplantation (PTx). METHODS: A retrospective review of 154 PTx performed over a 61-month period included 77 grafts preserved with UW and 77 with C. The two groups were comparable for both donor and recipient characteristics. RESULTS: After a mean cold ischemia time of 624 minutes (range 360 to 945 minutes) for UW versus 672 minutes (range 415 to 1005 minutes) for C (P = NS), no primary endocrine nonfunction occurred. Delayed endocrine function was diagnosed in two grafts in the UW group (2.6%) versus none in the C group (P = NS). After a minimum follow-up of 4 months (mean 26.5 +/- 15.2 months), 22 recipients (UW = 11 vs C = 11; P = NS) required relaparotomy. Overall, 18 pancreata were lost due to either patient death with functioning graft (UW = 4 vs C = 1; P = NS) or graft loss due to other reasons (UW = 8 vs C = 5; P = NS). Actuarial 1- and 5-year patient survival rates were 93.5% and 86.8% for UW compared with 98.7% and 98.7% for C (P = .04). Actuarial graft survival rates at the same times were 88.3% and 75.0% for UW compared with 90.4% and 90.4% for C (P = NS). CONCLUSIONS: Within the range of cold ischemia times reported in this study, UW and C show similar safety and efficacy profiles for PTx.

Renal vein extension in right kidney transplantation.

A short right renal vein may be associated with technical problems in renal transplantation. For this reason, a vena caval extension may be useful to improve exposure of the anastomosis and graft placement. This report evaluates the safety and the effectiveness of renal vein extension, which was routinely performed in right renal transplantation. From April 1986 to December 2002, we performed 371 right kidney transplantations with 252 using the standard technique (group A) and 119 using the renal vein extension (group B). No statistical differences were found between the 2 groups in terms of renal vein thrombosis incidence, delayed graft function, morbidity, and graft loss. Indeed, mean warm ischemia time was reduced in the venoplasty group. In conclusion, renal vein extension is an easy, safe technique that reduces warm ischemia time. We suggest more extensive use of this procedure in right kidney transplantation.

Pancreas preservation with University of Wisconsin and Celsior solutions.

BACKGROUND: Although the use of Celsior has been recently described for heart, lung, liver, and kidney transplantation, no data are available on its use for clinical pancreas preservation. METHODS: We herein describe the results of 112 pancreas transplants preserved with either University of Wisconsin (UW; (n = 56) or Celsior (n = 56) solution at two Italian transplant centers. The groups were comparable with regard to all donor and recipient characteristics. RESULTS: Mean cold and warm ischemia times were 10.1 +/- 2.2 hours and 37.2 +/- 8.2 minutes for UW compared to 10.8 +/- 2.4 hours and 38.3 +/- 6.7 minutes for Celsior (P = NS). Delayed endocrine pancreas function was recorded in two UW-preserved grafts (3.6%). Actuarial 1-year patient survival was 94.6% for UW as compared with 100% for Celsior (P = NS). Equivalent graft survival figures were 91.0% for UW as compared with 96.4% for Celsior (P = NS). CONCLUSIONS: Within the range of cold ischemia times reported in this study, UW and Celsior solutions have similar safety profiles for pancreas transplantation.