Background: Simultaneous pancreas-kidney transplantation (SPK) with portal-enteric drainage is physiological effective in treatment of patients with diabetes mellitus complicated by end-stage renal disease. A case is reported with a review of our clinical experience.
Methods: A patient with type 2 diabetes complicated by renal failure was subjected to SPK transplantation with portal-enteric drainage. Pancreaticoduodenal allograft procured from corpse was transplanted to recipient's right abdomen with donor's portal vein anastomosed to recipient's superior mesenteric vein. Donor's plastic pancreas artery was anastomosed to recipient's right common iliac artery and donor's duodenum anastomosed to recipient's jejunum. The kidney allograft was transplanted ectopically to the contralateral iliac fossa. Postoperative immunosuppression includes tacrolimus (TAC)/mycophenolate mofetil (MMF)-based regimen and methylprednisolone or prednisone.
Results: On the 5th postoperative day, the level of blood creatinine decreased from 590 micromol/L to normal. Daily urine volume was about 2500 ml. On the 18th postoperative day, insulin was given up, and the levels of fasting blood-glucose and after meal blood-glucose were kept normal. No acute rejection symptoms or other complications were observed except infection of Pseudomonas aeruginosa.
Conclusion: Combined pancreas and kidney transplantation with portal-enteric drainage is a physiological effective treatment for diabetic patients with end-stage renal disease.