Simultaneous Pancreas-Kidney Transplantation: A Single-Center Experience and Prospective Analysis M. Rossi, Q. Lai, G. Spoletini, L. Poli, F. Nudo, S. Ferretti, F. Della Pietra, F. Pugliese, G. Ferretti, G. Novelli, R. Pretagostini, and P.B. Berloco ABSTRACT In patients with end-stage chronic kidney disease (CKD) and type 1 diabetes mellitus (DM 1), simultaneous pancreas-kidney (SPK) transplantation is currently considered the gold stan- dard therapy. The aim of this study was to analyze and report the long-term clinical outcomes of the 23 SPK transplantations performed at our institution over an 84-month period (January 1, 2000 to December 31, 2006). A prospective analysis of these patients included donor, recipient, and transplantation characteristics. The only requirements for transplantation were blood group compatibility and a negative cross-match. Bladder drainage via pancreaticoduodenocystostomy was performed in all of the patients. Due to a pulmonary embolus 1 patient (4.3%) died at 2 months. The actuarial patient survival rates at 3 months and 1, 3, and 5 years were 95.6%. Causes for the renal graft loss were chronic allograft nephropathy in 3 cases (13%) and death of the patient in 1 case (4.3%). The actuarial censored renal allograft survival rates at 3 months and at 1 year were 100%, and at 3 and 5 years were 91.3%. Causes for the renal graft loss were chronic rejection in 1 case (4.3%) and patient death in 1 case (4.3%). The actuarial censored pancreatic allograft survival rates at 3 months and at 1 and 3 years were 100%, and at 5 years was 95.6%. The results of this work add further evidence that SPK is the gold standard therapy for selected patients with end-stage CKD due to DM 1. T YPE 1 diabetes mellitus (DM 1) caused by the loss of pancreatic beta cell function produces insulin defi- ciency. This pathology is associated with an increased risk of morbidity and mortality due to long-term macrovascular and microvascular pathological conditions, 1 like chronic kidney disease (CKD). 2 Clinical studies have demonstrated that simultaneous pancreas-kidney (SPK) transplantation for patients with end-stage CKD and DM 1 is associated with increased survival when compared with solitary de- ceased donor kidney transplantation or dialysis therapy. 3,4 SPK is currently the gold standard for these patients. 5 The aim of this study was to analyze the clinical outcomes of SPK transplantations at our institution. METHODS From January 1, 2000 to December 31, 2006, 23 SPK transplanta- tions were performed with all patients having a 1-year follow-up. No patient was excluded from the study. We performed a prospec- tive analysis of these patients. We analyzed donor age, gender, body mass index (BMI), blood group, natremia, glycemia, serum creatinine value, estimated cre- atinine clearance (CrCl; calculated with Cockcroft-Gault formula), intensive care unit (ICU) stay, episodes of hypotension, cardiac arrest, use of vasoactive drugs, and causes of death. Recipient age, gender, and BMI were analyzed. Cold ischemia time for the pancreatic and for the renal allograft were already analyzed. At the time of transplantation, blood group compatibility and negative cross-match were the only requirements for transplanta- tion. The perfusion always used University of Wisconsin (UW) solution. Regarding the surgical technique, a whole-pancreas tech- nique with bladder drainage via pancreaticoduodenocystostomy was used in all of the patients; only in 1 case was there a From the Chirurgia Generale e Trapianti d’Organo (M.R., Q.L., G.S., L.P., F.N., S.F., G.N., R.P., P.B.B.); Dipartimento di Scienze Anestesiologiche (F.D.P.), Medicina Critica e Terapia del Dolore (F.P.); and Dipartimento di Malattie Infettive e Tropicali (G.F.), La Sapienza Università di Roma, Umberto I Policlinico di Roma, Rome, Italy. The present study was supported by “Consorzio Inter- Universitario Per i Trapianti,” Director Prof. R. Cortesini. Address reprint requests to M. Rossi, Transplant Department, II Clinica Chirurgica, Policlinico Umberto I, Viale del Policlinico 155, Rome 00161, Italy. E-mail: m.rossi@uniroma1.it 0041-1345/08/$–see front matter © 2008 by Elsevier Inc. All rights reserved. doi:10.1016/j.transproceed.2008.05.059 360 Park Avenue South, New York, NY 10010-1710 2024 Transplantation Proceedings, 40, 2024 –2026 (2008)