Risultati del trapianto simultaneo di rene e pancreas: Esperienza su 148 casi

Aim: To evaluate the outcome of simultaneous pancreas transplantation (SKPT) focusing on the surgical technique applied. Patients and methods: One hundred forty-eight patients were submitted to SKPT: 33 with segmental pancreas with duct occlusion (from 1985 to 1990), 77 with whole pan areas with bladder diversion (from 1990 to 1998) and 38 whole pancreas with enteric diversion (29 with systemic and 9 with portal drainage) (from 1998 to December 2001). Results: Patient survival was 92%, 82%, 63% at 1, 5, and 10 years respectively. Kidney survival was 87%, 75%, and 48% at 1, 5, 10 years. Pancreas graft survival was 71%, 58%, and 46% at 1, 5, 10 years. In the enteric diversion group patient, kidney, panereas survival at one year was 93%, 92%, and 75%. A positive effect on patient survival was evident in enteric diversion versus duel ocdusion group (p = 0.03), but not versus bladder diversion group and on panereas graft survival in enterie diversion versus duet occlusion group (p <0.01). Conclusions: these data suggest that SKPE has become a successful intervention for patients with type I diabetes and end stage renal disease. Reasons for these improvements include improved donor and patient selection criteria, refi-nements in surgical technique and better immunosuppression.