100% PATIENT AND GRAFT SURVIVAL IN SIMULTANEOUS KIDNEY AND PANCREAS TRANSPLANTATION: VOLUME-OUTCOME EFFECT IN A SINGLE CENTER EXPERIENCE

Abstract

A142 Aims: A “volume-outcome” effect can probably affect patient survival in organ transplantation. We wanted to verify if an accurate selection of cadaveric donors and an early referral of recipients can overcome this potential problem in a small program of simultaneous kidney and pancreas transplantation (SPK). Methods: Over a 24-month period, 19 SPK was performed in 19 patients, while in 1 patient a PAK transplantation was done. There were 13 males and 7 females with a mean age of 37.7 yrs (27-50). In 19 cases the bladder and in 1 case the enteric drainage was used. In all cases the systemic venous drainage was used. Induction therapy with basiliximab antibody (20 mg days 0 and 4) has been used in all patients. Tacrolimus, mycophenolate mofetil and low-dose steroids have been used post-operatively. Organ retrieval was always performed in cadaveric donors with less than 5 days of ICU stay and a mean age of 25,5 years (17-41). All of them were hemodinamically stable with no more than 1 inotropic drug support and none required insulin before procurement. The mean cold ischemia time was 8.6 hrs for P (6.5-15) and 10.5 hrs (7.15-16.30) for K. Results: We achieved a 100% patient and graft survival (mean follow-up 18 m). All kidney and pancreas grafts functioned immediately without insulin requirement. In 5 patients (25%) mycophenolate mofetil was switched to Aza because of GI related complications. Four rejection episodes, clinically diagnosed, occurred in four patients, and were successfully treated with steroid pulses. Mean serum creatinine was 1.3 -+ 0.6. All patients are insulin free. Reoperation rate was 20% (4/20) : 1 anastomotic bleeding (Kidney), 2 abdominal dehiscence, and 1 incisional hernia. 7 patients suffered from infective complications (5 CMV and 2 bacterial infections) and 3 reflux pancreatitis. Five patients suffered multiple episodes of bacterial cystitis. Conclusions: Mantaining an early referral of recipients and strict selection of cadaveric donors, SKP transplantation can be performed safely with good to excellent patient and graft survival and good graft function even in a small (less than one procedure per month) transplantation program.