P-167

Pancreas/islet-kidney transplantation for patients with type 2 DM and end stage of renal disease

Y. Liu
First Hospital of China Medical University, General Surgery Department, Shenyang, Czech Republic

Objective: To explore the effect of pancreas/islet-kidney transplant for patients with DM(DM) and end stage of renal disease(ESRD).

Method: Since September 1999, 19 patients with type 2 DM and ESRD received simultaneous pancreas-kidney transplant in our hospital. All patients have a long history of diabetes( 10-20years), and were insulin-depended with dose of 0.2-1.0IU/Kg/day. Anti-CD25 monoclonal antibody /OKT3 were used as induction and cyclosporine A/ tacrolimus, mycophenolate mofteil(MMF) and steroid as maintenance protocol. Steroid was removedwithdrawn 6 months after operation.

SinceDecember 2007 , 4 cases of islet transplantation were performed for 4 patients with type 2 DM and ESRD. Two patients received simultaneous islet-kidney transplant from single-donor, one received 2 consecutive islet transplants 5 months after kidney transplant. All of recipients depended on insulin with dose of 0.5-0.7IU/Kg/day before operation. Anti-CD25 monoclonal antibody was used as induction. For simultaneous islet-kidney transplant, low-dose Tacrolimus and Sirolimus were used as maintenance protocol. For the other patient, the maintenance protocol was closporine andMMF. Steroid was not used in all cases.

Result: No Primary graft nonfunction (PNF) have occurred.Insulin was withdrawn within 5 to 9 days after operation. The results of insulin and C-peptide release test were normal. One patient died of secondary infection caused by bone marrow suppression. The other patients survived with functioning grafts. One patient of simultaneous islet-kidney transplant died of bleeding and secondary infection of liver puncture site 5 days after operation, the blood glucose level recovered to normal 24 hours. The other patient had normal glucose level 3 days after surgery, and the insulin dose reduced to 1/3. The insulin dose of the patient of islet transplantation after kidney transplantation reduced to 1/2 after the first transplant. The patient became insulin independent completely after the second operation.

Conclusion: Pancreas/islet transplantation is an effective treatment for patients with type 2 DM.

P-167

Pancreas/islet-kidney transplantation for patients with type 2 DM and end stage of renal disease

Y. Liu
First Hospital of China Medical University, General Surgery Department, Shenyang, Czech Republic

Objective: To explore the effect of pancreas/islet-kidney transplant for patients with DM(DM) and end stage of renal disease(ESRD).

Method: Since September 1999, 19 patients with type 2 DM and ESRD received simultaneous pancreas-kidney transplant in our hospital. All patients have a long history of diabetes( 10-20years), and were insulin-depended with dose of 0.2-1.0IU/Kg/day. Anti-CD25 monoclonal antibody /OKT3 were used as induction and cyclosporine A/ tacrolimus, mycophenolate mofteil(MMF) and steroid as maintenance protocol. Steroid was removedwithdrawn 6 months after operation.

SinceDecember 2007 , 4 cases of islet transplantation were performed for 4 patients with type 2 DM and ESRD. Two patients received simultaneous islet-kidney transplant from single-donor, one received 2 consecutive islet transplants 5 months after kidney transplant. All of recipients depended on insulin with dose of 0.5-0.7IU/Kg/day before operation. Anti-CD25 monoclonal antibody was used as induction. For simultaneous islet-kidney transplant, low-dose Tacrolimus and Sirolimus were used as maintenance protocol. For the other patient, the maintenance protocol was closporine andMMF. Steroid was not used in all cases.

Result: No Primary graft nonfunction (PNF) have occurred.Insulin was withdrawn within 5 to 9 days after operation. The results of insulin and C-peptide release test were normal. One patient died of secondary infection caused by bone marrow suppression. The other patients survived with functioning grafts. One patient of simultaneous islet-kidney transplant died of bleeding and secondary infection of liver puncture site 5 days after operation, the blood glucose level recovered to normal 24 hours. The other patient had normal glucose level 3 days after surgery, and the insulin dose reduced to 1/3. The insulin dose of the patient of islet transplantation after kidney transplantation reduced to 1/2 after the first transplant. The patient became insulin independent completely after the second operation.

Conclusion: Pancreas/islet transplantation is an effective treatment for patients with type 2 DM.