Simultaneous cadaver pancreas living-donor kidney transplantation: A new approach for the type 1 diabetic uremic patient

Alan C. Farney, Eugene Cho, Eugene J. Schweitzer, Brian Dunkin, Benjamin Philosophe, John Colonna, Stephen Jacobs, Bruce Jarrell, John L. Flowers, Stephen T. Bartlett

Research output: Contribution to journalArticle

Abstract

Objective. To review the authors' experience with a new approach for type I diabetic uremic patients: simultaneous cadaver-donor pancreas and living-donor kidney transplant (SPLK). Summary Background Data. Simultaneous cadaver kidney and pancreas transplantation (SPK) and living-donor kidney transplantation alone followed by a solitary cadaver-donor pancreas transplant (PAK) have been the transplant options for type I diabetic uremic patients. SPK pancreas graft survival has historically exceeded that of solitary pancreas transplantation. Recent improvement in solitary pancreas transplant survival rates has narrowed the advantage seen with SPK. PAK, however, requires sequential transplant operations. In contrast to PAK and SPK, SPLK is a single operation that offers the potential benefits of living kidney donation: shorter waiting time, expansion of the organ donor pool, and improved short-term and long-term renal graft function. Methods. Between May 1998 and September 1999, the authors performed 30 SPLK procedures, coordinating the cadaver pancreas transplant with simultaneous transplantation of a laparoscopically removed living-donor kidney. Of the 30 SPLKs, 28 (93%) were portally and enterically drained. During the same period, the authors also performed 19 primary SPK and 17 primary PAK transplants. Results. One-year pancreas, kidney, and patient survival rates were 88%, 95%, and 95% for SPLK recipients. One-year pancreas graft survival rates in SPK and PAK recipients were 84% and 71%. Of 30 SPLK transplants, 29 (97%) had immediate renal graft function, whereas 79% of SPK kidneys had immediate function. Reoperative rates, early readmission to the hospital, and initial length of stay were similar between SPLK and SPK recipients. SPLK recipients had a shorter wait time for transplantation. Conclusions. Early pancreas, kidney, and patient survival rates after SPLK are similar to those for SPK. Waiting time was significantly shortened. SPLK recipients had lower rates of delayed renal graft function than SPK recipients. Combining cadaver pancreas transplantation with living-donor kidney transplantation does not harm renal graft outcome. Given the advantages of living-donor kidney transplant, SPLK should be considered for all uremic type I diabetic patients with living donors.

Original languageEnglish (US)
Pages (from-to)696-703
Number of pages8
JournalAnnals of Surgery
Volume232
Issue number5
DOIs
StatePublished - 2000
Externally publishedYes

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Living Donors
Cadaver
Kidney Transplantation
Pancreas
Transplants
Kidney
Pancreas Transplantation
Survival Rate
Tissue Donors
Graft Survival
Transplantation
Delayed Graft Function
Patient Readmission
Length of Stay

ASJC Scopus subject areas

  • Surgery

Cite this

Simultaneous cadaver pancreas living-donor kidney transplantation : A new approach for the type 1 diabetic uremic patient. / Farney, Alan C.; Cho, Eugene; Schweitzer, Eugene J.; Dunkin, Brian; Philosophe, Benjamin; Colonna, John; Jacobs, Stephen; Jarrell, Bruce; Flowers, John L.; Bartlett, Stephen T.

In: Annals of Surgery, Vol. 232, No. 5, 2000, p. 696-703.

Research output: Contribution to journalArticle

Farney, AC, Cho, E, Schweitzer, EJ, Dunkin, B, Philosophe, B, Colonna, J, Jacobs, S, Jarrell, B, Flowers, JL & Bartlett, ST 2000, 'Simultaneous cadaver pancreas living-donor kidney transplantation: A new approach for the type 1 diabetic uremic patient', Annals of Surgery, vol. 232, no. 5, pp. 696-703. https://doi.org/10.1097/00000658-200011000-00012
Farney, Alan C. ; Cho, Eugene ; Schweitzer, Eugene J. ; Dunkin, Brian ; Philosophe, Benjamin ; Colonna, John ; Jacobs, Stephen ; Jarrell, Bruce ; Flowers, John L. ; Bartlett, Stephen T. / Simultaneous cadaver pancreas living-donor kidney transplantation : A new approach for the type 1 diabetic uremic patient. In: Annals of Surgery. 2000 ; Vol. 232, No. 5. pp. 696-703.
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abstract = "Objective. To review the authors' experience with a new approach for type I diabetic uremic patients: simultaneous cadaver-donor pancreas and living-donor kidney transplant (SPLK). Summary Background Data. Simultaneous cadaver kidney and pancreas transplantation (SPK) and living-donor kidney transplantation alone followed by a solitary cadaver-donor pancreas transplant (PAK) have been the transplant options for type I diabetic uremic patients. SPK pancreas graft survival has historically exceeded that of solitary pancreas transplantation. Recent improvement in solitary pancreas transplant survival rates has narrowed the advantage seen with SPK. PAK, however, requires sequential transplant operations. In contrast to PAK and SPK, SPLK is a single operation that offers the potential benefits of living kidney donation: shorter waiting time, expansion of the organ donor pool, and improved short-term and long-term renal graft function. Methods. Between May 1998 and September 1999, the authors performed 30 SPLK procedures, coordinating the cadaver pancreas transplant with simultaneous transplantation of a laparoscopically removed living-donor kidney. Of the 30 SPLKs, 28 (93{\%}) were portally and enterically drained. During the same period, the authors also performed 19 primary SPK and 17 primary PAK transplants. Results. One-year pancreas, kidney, and patient survival rates were 88{\%}, 95{\%}, and 95{\%} for SPLK recipients. One-year pancreas graft survival rates in SPK and PAK recipients were 84{\%} and 71{\%}. Of 30 SPLK transplants, 29 (97{\%}) had immediate renal graft function, whereas 79{\%} of SPK kidneys had immediate function. Reoperative rates, early readmission to the hospital, and initial length of stay were similar between SPLK and SPK recipients. SPLK recipients had a shorter wait time for transplantation. Conclusions. Early pancreas, kidney, and patient survival rates after SPLK are similar to those for SPK. Waiting time was significantly shortened. SPLK recipients had lower rates of delayed renal graft function than SPK recipients. Combining cadaver pancreas transplantation with living-donor kidney transplantation does not harm renal graft outcome. Given the advantages of living-donor kidney transplant, SPLK should be considered for all uremic type I diabetic patients with living donors.",
author = "Farney, {Alan C.} and Eugene Cho and Schweitzer, {Eugene J.} and Brian Dunkin and Benjamin Philosophe and John Colonna and Stephen Jacobs and Bruce Jarrell and Flowers, {John L.} and Bartlett, {Stephen T.}",
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T1 - Simultaneous cadaver pancreas living-donor kidney transplantation

T2 - A new approach for the type 1 diabetic uremic patient

AU - Farney, Alan C.

AU - Cho, Eugene

AU - Schweitzer, Eugene J.

AU - Dunkin, Brian

AU - Philosophe, Benjamin

AU - Colonna, John

AU - Jacobs, Stephen

AU - Jarrell, Bruce

AU - Flowers, John L.

AU - Bartlett, Stephen T.

PY - 2000

Y1 - 2000

N2 - Objective. To review the authors' experience with a new approach for type I diabetic uremic patients: simultaneous cadaver-donor pancreas and living-donor kidney transplant (SPLK). Summary Background Data. Simultaneous cadaver kidney and pancreas transplantation (SPK) and living-donor kidney transplantation alone followed by a solitary cadaver-donor pancreas transplant (PAK) have been the transplant options for type I diabetic uremic patients. SPK pancreas graft survival has historically exceeded that of solitary pancreas transplantation. Recent improvement in solitary pancreas transplant survival rates has narrowed the advantage seen with SPK. PAK, however, requires sequential transplant operations. In contrast to PAK and SPK, SPLK is a single operation that offers the potential benefits of living kidney donation: shorter waiting time, expansion of the organ donor pool, and improved short-term and long-term renal graft function. Methods. Between May 1998 and September 1999, the authors performed 30 SPLK procedures, coordinating the cadaver pancreas transplant with simultaneous transplantation of a laparoscopically removed living-donor kidney. Of the 30 SPLKs, 28 (93%) were portally and enterically drained. During the same period, the authors also performed 19 primary SPK and 17 primary PAK transplants. Results. One-year pancreas, kidney, and patient survival rates were 88%, 95%, and 95% for SPLK recipients. One-year pancreas graft survival rates in SPK and PAK recipients were 84% and 71%. Of 30 SPLK transplants, 29 (97%) had immediate renal graft function, whereas 79% of SPK kidneys had immediate function. Reoperative rates, early readmission to the hospital, and initial length of stay were similar between SPLK and SPK recipients. SPLK recipients had a shorter wait time for transplantation. Conclusions. Early pancreas, kidney, and patient survival rates after SPLK are similar to those for SPK. Waiting time was significantly shortened. SPLK recipients had lower rates of delayed renal graft function than SPK recipients. Combining cadaver pancreas transplantation with living-donor kidney transplantation does not harm renal graft outcome. Given the advantages of living-donor kidney transplant, SPLK should be considered for all uremic type I diabetic patients with living donors.

AB - Objective. To review the authors' experience with a new approach for type I diabetic uremic patients: simultaneous cadaver-donor pancreas and living-donor kidney transplant (SPLK). Summary Background Data. Simultaneous cadaver kidney and pancreas transplantation (SPK) and living-donor kidney transplantation alone followed by a solitary cadaver-donor pancreas transplant (PAK) have been the transplant options for type I diabetic uremic patients. SPK pancreas graft survival has historically exceeded that of solitary pancreas transplantation. Recent improvement in solitary pancreas transplant survival rates has narrowed the advantage seen with SPK. PAK, however, requires sequential transplant operations. In contrast to PAK and SPK, SPLK is a single operation that offers the potential benefits of living kidney donation: shorter waiting time, expansion of the organ donor pool, and improved short-term and long-term renal graft function. Methods. Between May 1998 and September 1999, the authors performed 30 SPLK procedures, coordinating the cadaver pancreas transplant with simultaneous transplantation of a laparoscopically removed living-donor kidney. Of the 30 SPLKs, 28 (93%) were portally and enterically drained. During the same period, the authors also performed 19 primary SPK and 17 primary PAK transplants. Results. One-year pancreas, kidney, and patient survival rates were 88%, 95%, and 95% for SPLK recipients. One-year pancreas graft survival rates in SPK and PAK recipients were 84% and 71%. Of 30 SPLK transplants, 29 (97%) had immediate renal graft function, whereas 79% of SPK kidneys had immediate function. Reoperative rates, early readmission to the hospital, and initial length of stay were similar between SPLK and SPK recipients. SPLK recipients had a shorter wait time for transplantation. Conclusions. Early pancreas, kidney, and patient survival rates after SPLK are similar to those for SPK. Waiting time was significantly shortened. SPLK recipients had lower rates of delayed renal graft function than SPK recipients. Combining cadaver pancreas transplantation with living-donor kidney transplantation does not harm renal graft outcome. Given the advantages of living-donor kidney transplant, SPLK should be considered for all uremic type I diabetic patients with living donors.

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