OBJECTIVE: To review the results of 1,000 consecutive simultaneous pancreas-kidney (SPK) transplants performed from December 1985 to December 2007.
METHODS: Bladder drainage was used in 390 (1985-1994) and enteric drainage in 610 (1994-present). More than 98% of all transplants were performed by three surgeons and followed in our clinic. Ninety-nine percent of grafts were procured by the local OPO and preserved in UW solution. Donor age ranged from 3 to 58 years and 56 were from donation after cardiac death (DCD).
RESULTS:

Outcome	Group	Survival
		1 Year	5 Year	10 Year	20 Year
Patient survival	All	96.7	88.7	79.7	57.8
	Pediatric donor	--	--	85.2	NA
Kidney graft survival	All	91.4	80.2	63.4	37.8
	Pediatric donor	--	--	80.1	NA
Pancreas graft survival	All	87.5	76.3	63.2	36.4
	Pediatric donor	--	--	72.6	NA

Pancreas and kidney survival from DCD donors at 10 years were 60% for the pancreas and 53% for the kidney (p=NS vs. standard donors). Bladder drainage was associated with a high incidence of urinary tract complications requiring 146 (38%) enteric conversions. Major indications included urine leak (34%), hematuria (24%), and recurrent UTI (19%). Induction with basiliximab and maintenance with tacrolimus, EC-MPS and low-dose prednisone proved to be the most successful and best tolerated immunosuppressive regimen. Over the 20-year follow-up, 30.6% of patients required kidney retransplantation, with 100% one-year patient and graft survival.
CONCLUSIONS: Considering that the annual mortality rate of diabetic patients on the wait list is 10.8% (Wolfe RA, N Engl J Med, 1999), a 57.8% survival and freedom from dialysis and insulin injections in more than one-third of patients at 20 years represents a major advance in transplant surgery and medicine.