Advantages and disadvantages of enteric versus bladder diversion in simultaneous kidney-pancreas transplantation.

Simultaneous kidney-pancreas transplantation is universally accepted as being the first-choice treatment for insulin-dependent diabetes mellitus in young patients with end stage renal disease. One hundred and fifty-six simultaneous kidney-pancreas transplantations were evaluated, namely, 33 segmental pancreas transplants with duct occlusion using neoprene (group I), 73 whole pancreas transplants with bladder diversion (group II) and 46 whole pancreas transplants with enteric diversion (group III) (37 with systemic venous drainage and 9 with portal diversion). Patient actuarial survival rates at 1, 5 and 10 years were 85%, 78% and 49%, respectively, in group I and 95%, 78% and 65% in group II. In group III the rates were 87% and 72% at 1 and 3 years, respectively. Kidney survival rates at 1, 5 and 10 years were 83%, 72% and 36% in group I and 89%, 78% and 59% in group II. In group III the survival rates were 85% and 72% at 1 and 3 years. Pancreas survival rates at 1, 5 and 10 years were 66%, 37% and 15% in group I and 73%, 67% and 65% in group II. In group III the rates were 87% and 68% at 1 and 3 years. Developments in the fields of organ retrieval technology, clinical immunosuppression and surgical technique have enabled us to improve our success rates, both in terms of organ survival and the quality of life of kidney-pancreas transplant recipients.