Simultaneous Pancreas and Kidney Transplantation: An Initial Experience in Southern India

Abstract

Introduction: Simultaneous pancreas-kidney transplantation (SPKT) is a well-documented therapy for insulin-dependent diabetes mellitus (IDDM) with end-stage renal disease (ESRD). Here, we share the initial reports of SPKT conducted at our institution. Patients and Methods: We performed five SPKT procedures in patients with IDDM and ESRD between April 2021 and April 2023. All grafts were procured from healthy, in-house, brain-dead donors. Results: The recipients included three males and two females, with a mean age of 35 ± 11.2 years. The mean duration of diabetes mellitus and time on dialysis were 17 ± 9.7 years and 21 ± 8.7 months, respectively. Donors had a mean age and body mass index of 27 ± 5.8 years and 23 ± 2.7 kg/m2. The mean glycated hemoglobin (HbA1c) and creatinine levels of donors at the time of donation were 5.6% ±0.27% and 0.98 ± 0.4 mg/dL. One recipient underwent pancreas removal due to a duodenal leak, and one developed kidney acute tubular necrosis. All recipients were on proper follow-up for a median period of 12 (4–18) months, with 100% patient survival, 80% pancreas, and 100% kidney survival. Average HbA1c, fasting blood sugar, and serum creatinine on follow-up were 5.5% ±0.7%, 84 ± 9.9 mg/dL, and 1 ± 0.16 mg/dL, respectively. Conclusion: In our initial experience with SPKT, recipient outcomes were comparable to results published in the literature. With proper graft selection, SPKT can be established in small-volume centers. Meticulous surgical technique and postoperative management remain key to the success of the transplant program.

Keywords

• diabetes
• pancreas transplant
• simultaneous pancreas and kidney transplant