ABSTRACT
Combined pancreas and kidney transplantation, performed either simultaneously or sequentially if a living donor is identified for the kidney, has become one of the standard treatment options for patients with type 1 diabetes and end-stage renal disease. The standard donor operation generally includes procurement of the liver, both kidneys, the whole pancreas with the duodenum, and less often the small intestine. A nasogastric tube is advanced into the duodenum of the donor and is irrigated with 25 mL of 1% povidone-iodine solution followed by 50 mL of cold saline solution. Surgical complications are more common after pancreas transplantation than after kidney transplantation. Nonimmunological complications of pancreas transplantation account for graft losses in 5%–10% of cases. Many of the technical problems associated with kidney–pancreas transplantation have been resolved, the incidence of associated thrombosis has diminished, and the management of exocrine secretions with bladder and enteric drainage now provides good results.
