Abstract
Purpose: Retrospective analysis of long term results regarding patient and graft survival, graft function and major complications in two patients after combined pancreas 4th-kidney 3rd and pancreas 3rd-kidney 2nd transplantation performed at our center. Methods: Patient 1: A 47 years old type I diabetic woman underwent a combined 4thpancreas - 3rd kidney transplantation after totally 2 immunological renal and 2 thrombotic pancreas graft losses and one immunological pancreas graft loss (explantation of the 2 previous kidney- and 2 pancreas-grafts). Cold ischemia time: 12:56 hours in the kidney and 15:14 in the pancreas. Patient 2: A 51 years old type diabetic men underwent a combined 3rd pancreas - 2nd kidney transplantation after immunological kidney and pancreas graft losses (explantation of the kidney graft). Cold ischemia time: 09:43 hours in the kidney of 09:43 hours and 11:30 in the pancreas. The multiple retransplantations were performed due to standard techniques. The basic immunosuppression consisted of Alemtuzumab, steroids, Tacrolimus, CellCept. The triple drug immunosuppression was maintained within a mean Tacrolimus trough level of 6 ng/mL until the current follow up time of 31 and 35 months posttransplant, respectively. Both patients are on permanent anticoagulation. Results: No immunological complication occurred apart from one reversible acute kidney rejection in patient 2 in month 1. Both patients are currently well within a stable pancreas and kidney function (mean serum creatinine 1.45 mg/dL, blood glucose 80 mg/dL). Leucopenia, thrombocytopenia, bacterial sepsis and chronic hepatitis C as major complications were controllable. Conclusion: Good results can be achieved in multiple pancreas- retransplantations in combination to a simultaneous renal transplantation. An explantation of previously non functioning grafts could be favorable. An exact immunosuppression and careful monitoring basing on an excellent patients adhaerance would contribute to good long term results.
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