No coin nor oath required. For personal study only.
Aims: To determine early outcomes following the introduction of a pancreas transplantation programme. Methods: A retrospective case note review of all patients undergoing pancreas transplantation between April 2000 and December 2002. Results: The first pancreas transplant was performed in this centre in April 2000. 20 patients have now undergone combined kidney pancreas transplantation and 2 patients pancreas only transplantation. The median age of donors was 29 (9-42). The median age of recipients was 45 (32-61). 15 patients were dialysis dependent. Pancreas transplantation was performed using a right intraperitoneal approach. A separate left iliac fossa incision was used for renal transplantation. Grafts were inserted without a venous extension graft directly on to the IVC, with a 'Y' [HG1]graft onto the common iliac artery and drained enterically. Routine immunosuppression consisted of tacrolimus, MMF and prednisolone. Renal allograft survival is 95% and pancreas allograft survival is 86% at a median follow up of 10 months (0-32). Five patients had delayed renal graft function requiring dialysis in the first 7 days (25%). Eleven patients required renal biopsy (55%) and six patients were treated for rejection (30%). One kidney failed 20 months post transplant due to rejection. Three pancreas grafts have failed due to fistula, arterial thrombosis and duodenal breakdown at 18, 25 and 23 days respectively. One of these patients died (overall mortality 4•5%). All remaining patients are free of insulin. Conclusions: Careful donor and recipient selection, a team approach to patient management and meticulous surgical technique result in good outcomes following pancreas transplantation.
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