Secondary kidney transplantation in a patient 16 years after simultaneous pancreas and kidney transplantation--a case report.

Simultaneous pancreas and kidney transplantation (spktx) is currently the most effective method of treatment of type 1 diabetes complicated by renal insufficiency. The first successful spktx in Poland was performed in the Department of General, Vascular and Transplant Surgery of the Warsaw Medical University on the 4th of February 1988. Since then 70 spktx were performed in our Department. We present a 44-year-old patient who after 16 years of good function of both transplanted organs presented with elevated creatinine levels (>4 mg/dl) as a result of chronic rejection of the kidney allograft. On the 22nd of January 2005 the patient underwent secondary kidney transplantation. The immunosuppresive protocol consisted of MMF, CsA and steroids. Humanized anti-lL-2 monoclonal antibodies (daclizumab) were used as pre-procedure induction. Using a mid-line incision the new kidney graft was anastomosed to the recipient left external iliac vessels. The ureter was anastomosed with the bladder without anti reflux procedures and the allograft was placed in the retroperitoneum below the previously transplanted kidney. Graftectomy of the first kidney allograft was not performed. After surgery, normal creatinine parameters were restored to a level of 1, 1 mg/dl and an increase in urine output was noted from 1 to 4 liters per day. Oral intake of foods was resumed on the 4th postoperative day and no early complications were observed. 12 months observation period confirmed stabile function of both transplanted organs. Secondary kidney transplantation in patients after spktx is technically possible and may be considered an option in patients with diminishing function of the first kidney allograft.

The comparison of treatment results of type 1 diabetes mellitus complicated by end-stage diabetic nephropathy in patients undergoing simultaneous pancreas and pre-emptive kidney transplantation (SPPkTx) and patients enrolled into the dialysis program--a cohort study.

OBJECTIVE: A cohort study was conducted to compare treatment of patients with type 1 diabetes mellitus and end-stage diabetic nephropathy. PATIENTS AND METHODS: 47 type 1 diabetic patients required renal replacement therapy in years: 2001-2005 were enrolled. Simultaneous pancreas and preemptive kidney transplant (sppktx) was performed in 18 (group I). Group II consisted of 29 patients who entered dialysis program. Survival rate for patients from both groups was estimated. Transplanted organ function was evaluated for group II. Lipid profile and its correlation with thickness of carotid media was assessed. Impact of sppktx on diabetic retinopathy was investigated. Cost and life quality were compared between groups. RESULTS: Two-year cumulative recipient survival rate for group I and II was 100% and 96%, respectively. One-year cumulative survival rate for transplanted pancreas was 88% and for kidney grafts 94%. In group I cholesterol and triglyceride level before transplantation were: 207 +/- 38 mg/dl and 133 +/- 65 mg/dl and decreased after transplantation to 155 +/- 20 mg/dl and 78 +/- 25 mg/dl, respectively (p < 0.05). No difference of carotid media thickness was observed between groups. Stabilization of retinopathy was observed in 91.6% non-blind recipients. During the first year of the follow-up the costs of transplantation doubled those of dialysis therapy but in the second year the costs of dialysis exceeded the costs required for transplanted patients. CONCLUSION: Despite of major surgery and introduction of immunosuppression in group I, results did not differ significantly between groups during a two-year follow-up. After sppktx, stabilization of the carotid media was slower than the normalization of lipids. At the second year, transplantation is less expensive than dialysis.