WTP2.11 Ipsilateral allograft placement in simultaneous pancreas and kidney transplantation provides equivalent outcomes to standard techniques

Abstract

Abstract Aims In simultaneous pancreas kidney transplantation (SPK) grafts are conventionally implanted controlaterally (cSPK), with the pancreas allograft (PG) on right iliac fossa and kidney allograft (KG) on the left. Ipsilateral implant (iSPK) of both grafts on the right side has been previously described but remains underutilised, potentially due to concerns regarding technical complications. We aimed to assess feasibility, safety and outcomes of an iSPK implantation technique. Methods A retrospective analysis of a contemporaneous database of SPK transplants was performed. Grafts laterality was noted (iSPK or cSPK) with implantation decision dependent on surgeon preference and recipient factors. Recipients’ characteristics, surgical outcomes and graft and patient survival rates were compared. Results 162 SPKs were performed (cSPK n=126 and iSPK n=36) between 2015-21. Recipient’s' demographics, indications, diabetic burden and comorbidities were comparable between the groups. Cold and and warm ischaemia times, intraoperative time, rates of complications, reoperation and readmission comparison showed no statistically significative difference between the 2 groups (p=NS). Survival rates for grafts (iSPK=97.2% vs cSPK=91.2%, p=NS) and patient (iSPK=97.2% vs cSPK=98.4%, p=NS) at 1 year follow-up was comparable as well. Conclusions In our experience iSPK appears to be a safe and feasible alternative, with comparable outcomes to cSPK. With increasing experience, iSPK could be offered to a larger number of recipients as there are no deterious effects on KG outcome. iSPK may provide benefit in reduction of operative time coupled with preservation of the contralateral side for future transplants, impacting on longer term patient longevity.