Surgical techniques used in simultaneous pancreas-kidney transplantation / 中华普通外科杂志

ABSTRACT

Objective To evaluate the surgical techniques and short-term clinical results of simultaneous pancreaticoduodenum-kidney transplantation(SPK)with the enteric drainage(ED)of exocrine secretions of the pancreas.Method From Jan 2005 to Jun 2009,ten diabetic patients with uremia diabetes underwent SPK.The pancreas graft was placed intraperitoneally with exocrine secretions drained into the proximal iejunum by side-to-side anastomosis.The multivisceral cluster grafts(liver,kidney,pancreas and duodenum)were procured after simultaneously rapid perfusion with cool UW solution through donor's abdominal aorta and superior mesenterie vein in 10 no heart beating cadeveric donors.Quadruple immunosuppressive therapy with anti-CD25 monoclonal antibody,tacrolimus,mycophenolate mofetil and steroids was adopted.Results SPK was successfully performed in all cases.The mean warm ischemia time of donor organ was(5.9 ±2.6)min,the mean cold ischemic time of the kidney was(5.2 ±2.2)hours and that of the pancreas was(9.3±3.6)hours.Patient and graft survival rates were 90.0% and 90% at 6 month after transplant,respectively.None of the grafts lost due to enteric or pancreatic leakage or intraabdominal infection.The most common surgical complications were wound infection(n=3),and enteric anastomostic hemorrage(n=2),which were all cured by nonoperative management.Three biopsy-proven acute renal rejection episodes occurred within 12 months postoperation,2 of them were reversed Successfully.and 1 died of cerebral complication during the recovery from continuous renal replacement therapy(CRRT)after the failure of aggressive antirejection treatment.Other patients(n=9)became insulin-free euglycemie at(9.3±3.8)day postoperatively,and are well and insulin-free at a follow-up of 6～12 months.Conclusions High quality procurement of donor grafts and suitable arterioplasty are prerequisites for a successful combination kidney and pancreas transplantation.Enteric exocrine drainage by direct side-to-side anastomosis seems to be a simple and reliable technique.