Early rejection and pathological changes in combined pancreaticoduodenal and kidney allotransplantation in pigs.

Objective: To study the markers of early rejection and pathological changes in simultaneous pancreaticoduodenal and kidney transplantation (SPKT).

Methods: Thirty hybrid pigs were used as donors and recipients. A renoportal end-to-end anastomosis between the left renal vein and the distal end of the portal vein was performed. Two vascular end-to-side anastomoses between the donor portal vein and recipient inferior vena cava, and between the donor aortic segment including the celiac and superior mesenteric, and left renal arteries and recipient abdominal aorta were carried out. Pancreas exocrine secretion drainage was established with duodenocystostomy. Ureterostomosis of the graft was performed. Urine amylase level, fasting blood glucose and urine volumes of kidney allograft were monitored, and pathological changes of graft were observed.

Results: Of 15 recipients, 2 died of disturbance of internal environment and anastomotic bleeding, respectively. Satisfactory results were obtained in the remaining 13 recipients. The changes of urine amylase concentration were prior to those of fasting blood glucose and urine volumes of kidney allograft. The degree of rejection of the kidney allograft was more severe than that of the pancreas and duodenum allograft.

Conclusions: Urine amylase is the early marker of acute rejection in SPKT with bladder drainage of pancreatic exocrine secretion. The pathological change of kidney allograft is most significant in SPKT.