Pancreas retransplantation in patient with previous simultaneous pancreas kidney transplantation (SKP)--first case in Poland.

Pancreatic transplantation is a generally accepted treatment modality for patients with type I diabetes mellitus to control metabolism of glucose and prevent complications of diabetes. Graft thrombosis, chronic rejection, surgical complications are the leading cause of pancreatic graft loss among diabetic patients who undergo pancreas transplantation. Pancreas retransplantation is an important option for patients, who lost their primary pancreatic grafts. The 1-year graft survival rates for pancreas retransplantations are comparable to a primary pancreas transplantation. We report a case of pancreas retransplantation in 51-year-old male with a history of type I diabetes mellitus of a 40-year duration, after SKP 20 month before and graft pancreatectomy because of thrombosis 2 weeks after SKP. Pancreatic graft was placed on the right side of the pelvis and enteric drainage was used. Immunosuppressive regimen included daclizumab and thymoglobulin for induction, and mycophenolate mofetil, tacrolimus and short-term steroids for the maintenance of treatment. Four reexplorations were performed due to donor duodenum perforation caused by the stricture of the intestine situated in the area of previous anastomosis or/and after the transplant pancreatectomy. Enteroplasty was performed. Three months after surgery the patient remains normoglycemic, insulin-independent with good kidney function.