Simultaneous Pancreas and Kidney Transplantation From Live Donors. -Outcome of Recipients and Donors of Sixteen Consecutive Clinical Trials in a Single Institution-.

Abstract

We have firstly introduced a simultaneous pancreas and kidney transplantations from live donors (LDSPK) and sixteen cases have been performed in our institution. Patients and Methods: [Recipients] 16 type 1 diabetic patients with ESRD underwent LDSPKs. Age and gender were 34.2+5.7 years and 6 males/10 females. All patients showed negative serum C-peptide (<0.03ng/ml). [Donors] Donors were 9 mothers, 3 fathers and 4 brothers/sisters. 6 cases were ABO-incompatible. All donors showed both normal endocrine and renal function and fulfilled the Japanese criteria. [Immunosuppression] Immunosuppression was achieved by a quadruple therapy with tacrolimus, MMF, predonisolone, and basiliximab. For ABO-incompatiblecases, desensitization with rituximab, DFPP and PEX was performed. Results: Although a pancreatic fistula was developed in one donor, it was cured by conservative therapy. Another donor developed a pancreatic pseudo-cyst and needed aspiration through the stomach by gastro-scope. Other 14 donors showed no complication including, diabetes and renal dysfunction. However, long-term (over 5 years) follow-up data of the donor demonstrated the significant deterioration of insulin secretion and elevated HbA1C. One recipient developed primary nonfunction of the pancreas graft. Another patient developed venous thrombosis. Other 14 patients achieved insulin independency. These patients are maintaining insulin independency with positive serum CPR(2-7ng/ml) and showed the normal endocrine function evaluated by HbA1C, HOMA-beta, HOMA-R and 75g-OGTT. All 6 patients from ABO incompatible donors achieved insulin independency (100%) and withdrawal from hemodialysis (100%). Conclusions: The results of the consecutive clinical trial in our institution demonstrated that LDSPK must be recommended as a potent tool of treatment for type 1 diabetic patients with ESRD especially in our country. However, long term follow-up and care for the donors not to develop diabetes should be essential in performing LDSPK.