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Introduction L’impact de la transplantation pancreatique (TP) apres transplantation renale a donneur vivant (TRDV) sur la survie et sur la fonction a long terme des greffons renaux est encore incertain. L’objecitf de l’etude a ete de determiner si la survie et la fonction des greffons renaux sont alterees par la TP. Patients et methodes Nous avons analyse toutes les TRDV realisees entre janvier 1995 et decembre 2003 chez les patients diabetiques au sein notre institution. 106 patients ont beneficie d’une TP, 2 a 12 mois apres la TRDV (Groupe TP). 75 patients eligibles pour une TP apres TRDV, mais ayant refuse celle-ci pour des raisons personnelles, ont ete utilises comme temoins (Groupe TRDV). Le suivi median etait de 78,2 et 82,7 mois dans les deux groupes. Le debit de filtration glomerulaire (DFG) a ete calcule a l’aide de la formule MDRD. La survie des greffons renaux a ete determinees grâce a la methode de Kaplan Meier. Resultats Les patients du groupe TP etaient significativement plus jeunes (42,1 ± 7,8 vs 45,7 ± 10,6, p = 0,008) et presentaient majoritairement un diabete de type I (93 % vs 76 %, p = 0,0008). Aucune difference de survie des patients n’a ete mise en evidence. La survie du greffon a 1, 3 et 5 ans etait de 98,1 %, 91,5 %, 81,5 % dans le groupe TR, 100 %, 94,6 %, 84,3 % dans le groupe TP (p = 0,86). L’analyse de DFG a court terme n’a pas montre de difference significative entre les deux groupes. Par contre, apres 4 ans de suivi, le DFG etait significativement plus eleve dans le groupe TP que dans le groupe TRDV (52,91 ± 20,42 vs 43,28 ± 16,18 ml/min, p = 0,016). L’HbA1c post TP a court et long terme etait significativement plus basse dans le groupe TP que dans le groupe TR (HbA1c a 1 an, 5,35 % contre 7,5 %, p = 0,0007, HbA1c a 5 ans, 5.6 % contre 7.5 % TR, p Conclusion La transplantation pancreatique apres transplantation renale a donneur vivant n’altere pas la fonction ni la survie du greffon renal. Elle est au contraire associee a un meilleur controle glycemique et a une meilleure fonction renale a long terme.

Technical failure of the pancreas graft after a simultaneous pancreas-kidney (SPK) transplant is not uncommon, affecting roughly 10% of SPK recipients. These patients often recover with good kidney function, but have persistent issues related to their diabetes. The aim of this study was to determine if these patients were good candidates for a later pancreas retransplant. Outcomes were compared between 21 PASPK (pancreas after SPK) recipients and 361 recipients of a primary pancreas after kidney (PAK) transplant. Except for kidney graft source, there was no significant difference in the demographic characteristics between these two groups. In general, early surgical complications were more common in PASPK than PAK recipients (47.6% vs. 35.5%, p = 0.15), although the difference was not statistically significant. The incidence of acute rejection was no different between these two groups (28% vs. 33%, p = NS). At three yr post-transplant, patient and pancreas graft survival rates were also no different between the two groups (p = NS). The most common cause for graft loss in both groups was acute or chronic rejection. In conclusion, pancreas retransplant is a viable option for SPK recipients experiencing early technical failure of the pancreas graft. These recipients are not at higher immunologic risk vs. primary PAK recipients.

A recent article by K. W. Kercher, B. T. Heniford and B. D. Matthew et al., demonstated fewer hospital days, fewer complications and more rapid recovery with laparoscopic nephrectomy than with open surgery. The benefits of laparoscopy are becoming more apparent with improvements in techniques. Until recently, laparoscopic pneumoperitoneum was initiated and maintained by carbon dioxide gas at 20 C and less than 0.0002% relative humidity. It has been shown that the use of heated humidified gas for laparoscopy is beneficial in terms of reduced hypothermia, reduced postoperative pain scores, shortened recovery time, reduced pain medication use, and less peritoneal damage [1–5 ]. Our group at the University of Minnesota found results similar to those reported by Kercher when we used cold dry gas for insufflation, additional improvements were demonstrated when the gas was insufflated at 35 C and 95% relative humidity using the Insuflow device. We used the device for 10 laparoscopic donor nephrectomies and compared it with 10 contemporaneous controls conditions in which the device was not used. Although the length of hospital stay and analgesic requirements were not different between the groups, we found that the Insuflow patients had a decreased incidence of shoulder pain and rigor. At the end of the procedure 70% of the control group were hypothermic (

An adult-to-adult living donor liver transplant (LDLT) has emerged as a possible option to help alleviate the organ shortage. The aim of this study was to analyze our experience with biliary complications in LDLT recipients and to identify their risk factors for biliary complications. This paper aimed to describe therapeutic interventions and to evaluate the impact of biliary complications on long-term patient and graft survival rates.We evaluated biliary complications in a cohort of 120 LDLT recipients at a single institution and studied the impact on long-term graft and patient survival.Of the 120 recipients, 26 (21.7%) developed biliary complications. Endoscopy was the initial choice of treatment for recipients with biliary complications. The median time for resolution of bile leaks was 37 days; for resolution of strictures, 82 days. A decreased risk of biliary complications was associated with an interrupted duct-to-duct (versus continuous choledocho-choledochostomy) (hazard ratio [HR]=0.22, P=0.002) and a Roux-en-Y hepaticojejunostomy (HR=0.13, P0.001). In multivariate analysis of factors associated with graft failure and patient mortality, biliary complications were unrelated to long term (3 and 5 years) graft failure or patient mortality.In our study LDLT recipients had a 21.7% incidence of biliary complications, however, with successful endoscopic techniques, long-term patient and graft survival rates were not negatively affected.