ISRN Transplantation The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. A Hemodynamic Study to Evaluate the Buffer Response in Cirrhotic Patients Undergoing Liver Transplantation Tue, 18 Mar 2014 00:00:00 +0000 The physiological regulation of the liver blood flow is a result of a reciprocal portal vein and hepatic artery flow relationship. This mechanism is defined as the hepatic arterial buffer response (HABR). This study was addressed to investigate whether HABR is maintained in denervated grafts in liver transplant recipients. Portal blood flow (PBF) and hepatic arterial resistance index (PI) were measured 6 months after transplantation using Doppler. In each patient we consecutively measured the vasodilator (Ensure Plus PO versus placebo) and vasoconstrictor (isosorbide dinitrate 5 mg SL versus placebo) stimuli. The meal ingestion caused a significant increase of both parameters, PBF (from to  mL/min, ) and PI (from to , ). By contrast, isosorbide dinitrate reduced PBF (from to  mL/min, ) and PI (from to , ). We show that PBF and PI are reciprocally modified with the administration of vasoconstrictor and vasodilator stimuli. These results suggest the persistence of the HABR in a denervated human model, suggesting that this mechanism is independent of the regulation from the autonomic nervous system. Margarita Anders, Daniel Alvarez, Emilio Quiñonez, Federico Orozco, Nicolas Goldaracena, Lucas McCormack, and Ricardo Mastai Copyright © 2014 Margarita Anders et al. All rights reserved. Long-Term Outcome of Liver Transplantation in HIV-1-Positive Patients: 15-Year Follow-Up Wed, 25 Dec 2013 14:07:08 +0000 Liver transplantation (LT) for patients with human immunodeficiency virus type-1 (HIV-1) infection has been associated with poor outcome. However, after the introduction of the highly active antiretroviral therapy, short-term patient survival after LT has improved significantly. We examined the long-term outcome of HIV-1-positive patients who underwent LT. Medical records were analysed in nine HIV-1-positive LT patients who underwent LT from August 1998 to May 2012. Eight were known to be HIV-1 positive at the time of listing for LT and had end-stage liver disease (ESLD) due to hepatitis C. One patient had primary biliary cirrhosis, and primary HIV-1 infection was found at the date of LT. Seven of the nine patients remain alive to date. So far, three have survived more than 12 years after LT. The overall patient survival rate for both five and 10 years is 77.8%. Four patients experienced acute rejection and six acquired biopsy-confirmed HCV recurrence. HIV-1 replication was effectively blocked during follow-up in all patients. We conclude that long-term survival of HIV-1-positive patients after LT can be achieved. Our study suggests that LT can offer an effective treatment option in selected HIV-1 infected patients with ESLD. Shinji Yamamoto, Robert Schwarcz, Ola Weiland, Antti Oksanen, Annika Wernerson, Gunnar Söderdahl, Anders Sönnerborg, and Bo-Göran Ericzon Copyright © 2013 Shinji Yamamoto et al. All rights reserved. Effects of Rituximab on the Development of Viral and Fungal Infections in Renal Transplant Recipients Sun, 03 Nov 2013 14:02:11 +0000 Background. Rituximab is becoming increasingly utilized in renal transplant recipients; however, its association with infections remains unclear. Methods. We reviewed the incidence of viral and fungal infections in kidney transplant recipients treated with () or without () rituximab (RTX) in addition to standard immunosuppression. Results. Infections occurred in 134 (30%) patients, with a greater proportion in RTX versus no RTX patients (47% versus 28%; ). Viral infections occurred in 44% and 27% of RTX and no RTX patients, respectively (). This was largely driven by the frequency of BK viremia and noncytomegalovirus/non-BK viruses in RTX patients (27% versus 13% () and 15% versus 2% (), resp.). Fungal infections also occurred more often in RTX patients (11% versus 3 %; ). Multivariate analysis revealed deceased donor recipient (odds ratio = 2.5; ) and rituximab exposure (odds ratio = 2.2; ) as independent risk factors for infection. Older patients, deceased donor recipients, those on dialysis longer, and those with delayed graft function tended to be at a greater risk for infections following rituximab. Conclusions. Rituximab is associated with an increased incidence of viral and fungal infections in kidney transplantation. Additional preventative measures and/or monitoring infectious complications may be warranted in those receiving rituximab. Samir J. Patel, Jennifer M. Devos, Richard J. Knight, Kyle L. Dawson, Wadi N. Suki, Juan M. Gonzalez, Abdul A. Abdellatif, and A. Osama Gaber Copyright © 2013 Samir J. Patel et al. All rights reserved. Cell Transplantation and “Stem Cell Therapy” in the Treatment of Myopathies: Many Promises in Mice, Few Realities in Humans Mon, 21 Oct 2013 09:57:05 +0000 Myopathies produce deficits in skeletal muscle function and, in some cases, progressive and irreversible loss of skeletal muscles. The transplantation of myogenic cells, that is, cells able to differentiate into myofibers, is an experimental strategy for the potential treatment of some of these diseases. The objectives pursued by the transplantation of these cells are essentially three: (a) the fusion with the patient’s myofibers to obtain the expression of therapeutic proteins into them, (b) the neoformation of new functional myofibers in skeletal muscles that were too degenerated by the progressive degeneration, and (c) the formation of a new pool of healthy donor-derived satellite cells. Although the repertoire of myogenic cells appears to have expanded in recent years, myoblasts are the only cells that have been demonstrated to engraft in humans. The present work aims to make a comprehensive review of the subject, from its beginnings to recent advances, including the preclinical experience in different animal models and recent clinical findings. Daniel Skuk Copyright © 2013 Daniel Skuk. All rights reserved. Sicker Patients for Liver Transplantation: Meld, Meld Sodium, and Integrated Meld’s Prognostic Accuracy in the Assessment of Posttransplantation Events at a Single Center from Argentina Sat, 28 Sep 2013 12:08:06 +0000 Background. MELD or MELD sodium promotes sicker patients for earlier liver transplantation (LT); the balance between pre- and post-LT outcomes is still controversial. Aim. To compare MELD and related scores’ risk assessment of short-term morbidity and mortality after LT. Methods. We included only transplanted cirrhotic patients from 6/2005 to 6/2010 (). Immediate pre-LT MELD, integrated MELD (iMELD), and two MELD sodium formulas “MELD Na1” and “MELDNa2” were calculated. Results. Pre-LT scores for nonsurvivors were higher than those for survivors: MELD (28 ± 8 versus 22 ± 7, ), MELD Na1 (33 ± 8 versus 27 ± 10, ), and iMELD (51 ± 6 versus 46 ± 8, ). Patient survival assessment was performed by AUROC analysis (95% CI): MELD 0.694 (0.56–0.82; ), MELD Na1 0.682 (0.56–0.79; ), MELD Na2 0.651 (0.54–0.76; ), and iMELD 0.698 (0.593–0.80; ). Patients with MELD ≥25 points had longer intensive care stay (mean 10 versus 7 days, ) and longer mechanical ventilatory support (5.4 versus 1.9 days, ). Conclusions. The addition of serum sodium to MELD does not improve assessment of mortality after LT. Patients with higher MELD may preclude higher morbidity after transplantation. Federico Piñero, Sebastián Marciano, Alejandra Villamil, Juan Bandi, Paola Casciato, Omar Galdame, Sergio Giannasi, Eduardo de Santibañes, and Adrian Gadano Copyright © 2013 Federico Piñero et al. All rights reserved. The Impact of Graft Nephrectomy on Subsequent Transplants: Multivariate Analysis of Risk Factors for Second Graft Loss and for Multiple Transplantations–A Single-Center Retrospective Study Mon, 16 Sep 2013 13:38:17 +0000 Introduction. The management of a failed primary allograft remains unclear and the evidence of the effect of transplantectomy to future transplants conflicting. Aim of this study is to review the impact of failed primary graft nephrectomy on future transplants. Materials/Methods. Retrospective study of 101 patients retransplanted in a single institution. Median follow-up was 68 months. Patients were divided into two groups; G1 () was the nephrectomy group; G2 () was the graft in situ group. The patients’ and second graft survival were analysed with the Kaplan-Meier method. The patients’ and transplant characteristics were analyzed with student’s -test. The retransplant risk factors and the risk factors for multiple transplants were obtained via a logistic regression model. Results. The odds of second graft loss post-transplantectomy were high (OR = 5.24). Demographics, HLA mismatch and first graft rejection rates were similar among the two groups and did not affect the outcome. Transplantectomy accelerated the loss of a future failing graft. Multivariate analysis showed transplantectomy as independent risk factor for second allograft loss. Transplantectomy and younger age are significant independent risk factors for future multiple transplants. Conclusion. Transplantectomy of the failed primary graft is an independent risk factor for retransplant loss and for multiple renal transplants. Emmanouil Giorgakis, Asim Syed, and Hector Gonzalez Copyright © 2013 Emmanouil Giorgakis et al. All rights reserved. Development of Self-Management Scale for Kidney Transplant Recipients, Including Management of Post-Transplantation Chronic Kidney Disease Sun, 01 Sep 2013 10:19:18 +0000 An evaluation scale is indispensable for the promotion of continuing, effective postkidney transplantation self-management behaviors. We aimed to develop and validate a new self-management scale for kidney transplant recipients to improve their long-term outcomes and prevent the recurrence of CKD complications. Two hundred and thirty-nine Japanese patients who had undergone kidney transplantation were recruited from three hospitals. The scale’s validity and reliability were evaluated using exploratory factor analysis and intraclass correlation coefficients. Scale items were selected by considering the findings of a clinical importance survey of 17 experts. Four subscales were identified by the factor analysis: “Self-monitoring” (six items), “Self-care behavior in daily living” (seven items), “Early detecting and coping with abnormalities after kidney transplantation” (four items), and “Stress management” (three items). Cronbach’s alpha coefficients for the subscales ranged from 0.61 to 0.87. A further four items with high clinical importance were added to the scale. The final scale comprised 24 items within four subscales and four single items. The intraclass correlation ranged from 0.88 to 0.95 in each subscale and the weighted kappa coefficient for the single items ranged from 0.33 to 0.72. The validity and reliability of our new self-management scale were confirmed by a patient-based field survey. Shiho Kosaka, Makoto Tanaka, Tomoko Sakai, Shinji Tomikawa, Kazunari Yoshida, Tatsuya Chikaraishi, and Keiko Kazuma Copyright © 2013 Shiho Kosaka et al. All rights reserved. Posttransplant Lymphoproliferative Disorder after Cardiac Transplantation in Children: Life Threatening Complications Associated with Chemotherapy Combined with Rituximab Mon, 17 Jun 2013 18:48:28 +0000 Despite the excellent long-term survival currently achieved in pediatric heart transplant recipients, posttransplant lymphoproliferative disorders (PTLDs) are one of the most important causes of morbidity and mortality after heart transplantation (HTx), especially in children. Timely and accurate diagnosis based on histological examination of biopsy tissue is essential for early intervention for PTLD. Chemotherapy is indicated for patients with poor response to reduction of immunosuppressive medication and for highly aggressive monomorphic PTLD. The use of rituximab in combination with chemotherapy is effective to suppress B cell type PTLD (B-PTLD). However, PTLD relapses frequently and the outcome is still poor. Although everolimus (EVL) has been reported to inhibit growth of human Epstein-Barr-virus- (EBV-) transformed B lymphocytes in vitro and in vivo, EVL has several side effects, such as delayed wound healing and an increase in bacterial infection. During combined treatment of chemotherapy and rituximab, B-PTLDs are sometimes associated with life-threatening complications, such as intestinal perforation and cardiogenic shock due to cytokine release syndrome. In HTx children especially treated with EVL, stoma should be made to avoid reoperation or sepsis in case of intestinal perforation. In cases with cardiac graft dysfunction possibly due to cytokine release syndrome by chemotherapy with rituximab for PTLD, plasma exchange is effective to restore cardiac function and to rescue the patients. Norihide Fukushima Copyright © 2013 Norihide Fukushima. All rights reserved. Expanded Criteria Donors in Kidney Transplantation: The Role of Older Donors in a Setting of Older Recipients Tue, 04 Jun 2013 14:58:19 +0000 Kidney transplantation (KT) is the therapy of choice for end-stage renal disease (ESRD). The ESRD population is aging and so are patients waiting for KT. New strategies have been made for increasing the donor and recipient pools, and as a consequence kidneys from older donors or donors with significant comorbidities, the so-called “expanded criteria donor” (ECD) kidneys, are used for transplantation. Although good outcomes have been achieved from ECD, several issues are still waiting for clarification and need to be discussed. The concept of age matching is accepted as a method to ameliorate utilization of these allografts, but an optimal and widely accepted strategy is still not defined. The development of machine perfusion and the dual kidney transplantation are techniques which further improve the outcome of transplants from ECD, but the described experiences are scarce or coming from small single institutional reports. Also due to age-related immune dysfunction and associated comorbidities, the elderly recipients are more susceptible to immunosuppression related complications (e.g., infections and malignancy), although a widely accepted and validated immunosuppressive regimen is still lacking. In this paper, we review the issues related to KT employing allografts from marginal donors with a particular interest for the elderly patients. Paride De Rosa, Giovanna Muscogiuri, and Gerardo Sarno Copyright © 2013 Paride De Rosa et al. All rights reserved. Renal Transplantation Is Associated with Improved Clinical Outcomes in Nephrogenic Systemic Fibrosis Wed, 24 Apr 2013 15:06:48 +0000 Nephrogenic systemic fibrosis is a debilitating disorder seen in chronic kidney disease patients and is characterized by stiffening of the joints and thickening of the skin. Treatment options are limited, but some patients have had an improvement of their clinical symptoms after renal transplantation and the use of immunosuppression. Although there is a variable response to renal transplantation, it is currently unknown what factors promote a favorable outcome. Our objective was to evaluate if the response to renal transplantation was superior to other treatment modalities and to determine which characteristics allowed for a positive response to occur. We retrieved the data from the literature of 298 reported patients, compared the response to renal transplantation and to other treatments, and analyzed their characteristics. We found that more patients had a higher response to renal transplantation, as determined by softening of the skin and improved joint mobility, and among those that did respond, they had a shorter dialysis vintage. We suggest that if renal transplantation is to be considered as a treatment modality, it should be initiated at the earliest possible in the course of the disease to achieve maximum clinical benefit. Rabi Yacoub, Kiran Kandukurti, and Mandip Panesar Copyright © 2013 Rabi Yacoub et al. All rights reserved. Kidney Transplantation from Donors with Severe Disseminated Intravascular Coagulation Wed, 27 Feb 2013 08:24:35 +0000 Disseminated intravascular coagulation (DIC) is a syndrome characterized by massive formation of thrombin, which can lead to renal dysfunction or failure. Many transplant centers are reluctant to accept the kidneys from donors with DIC especially if renal dysfunction is present. We developed protocol of machine perfusion followed by tissue plasminogen activator (tPA) infusion in order to treat and evaluate DIC kidneys prior to transplantation. The kidneys were placed on machine preservation with tPA added to the perfusate prior to transplantation. Three kidneys were transplanted from two donors who sustained gunshot injuries to the brain. A biopsy at the time of organ recovery documented widespread fibrin thrombi in approximately 80% of the glomeruli. Serial biopsies showed interval improvement following machine perfusion and a normal appearing kidney three months after successful transplantation. The histological presence of DIC in a deceased organ donor, even if associated with renal dysfunction, is not a contraindication to renal transplantation. Machine perfusion and tPA infusions may contribute to the recovery and successful transplantation of such kidneys. Lena Sibulesky, Reginald Gohh, Kevin Charpentier, and Paul Morrissey Copyright © 2013 Lena Sibulesky et al. All rights reserved. Comparing Surgical Complications of Donors and Recipients in Retroperitoneoscopic versus Mini-Incision Donor Nephrectomy: A Single-Center Experience Mon, 28 Jan 2013 08:56:19 +0000 Anterior vertical mini-incision donor nephrectomy (MIDN) has been used as the standard retrieval procedure in our center. Though the MIDN approach was tolerated very well with low complication rates, there were especially cosmetic reasons, to consider a change of procedure. Hence we switched to a total retroperitoneoscopic donor nephrectomy (RPDN) in 2011. We compared the outcome and surgical complications of donors and recipients of the first 30 RPDNs performed with 30 consecutive MIDN procedures. In both techniques, right and left nephrectomies were carried out. After a very short learning curve, the mean RPDN operation times were shorter compared to the MIDN (109 versus 171 min, ) and donors were discharged earlier. No major complications occurred in the RPDN group and complications were less frequent compared to MIDN (17% versus 40%). The renal function in the recipients was equivalent in both groups at the time of discharge and after one year. We conclude that RPDN is easy to learn for a surgical team experienced in open retroperitoneal donor nephrectomy. The change of the retrieval technique is safe for the donor and the recipient regarding surgical complications and recipients’ renal function. Donors benefit from RPDN due to earlier hospital discharge and faster recovery. Martina Koch, Alexander Bachmann, and Bjoern Nashan Copyright © 2013 Martina Koch et al. All rights reserved. Low-Dose Valganciclovir for CMV Prophylaxis after Lung Transplantation Tue, 04 Dec 2012 15:26:18 +0000 Purpose. Cytomegalovirus (CMV) remains an important pathogen following solid organ transplantation (SOT). Universal prophylaxis for CMV is adopted by most centers after lung transplantation. Various combinations studied for CMV prophylaxis include intravenous and oral ganciclovirs, oral valganciclovir, and CMV immunoglobulins. We present our experience with a low-dose of oral valganciclovir for CMV prophylaxis following lung transplantation. Methods and Materials. Our center started using 450 mg of daily oral valganciclovir for CMV prophylaxis in lung transplant recipients in Jan, 2001. A retrospective chart analysis of patients who underwent lung transplantation from January 2001 to December 2006 was done. Of 46 patients, 4 were excluded as they died within 30 days of transplant from postop complications. The mean age at transplant was 64 years, mostly single lung transplants (36/6) with a male-to-female ratio of 25/17. COPD was the most common reason for transplant (65%), and the serological CMV status of donors (D) and recipients (R) was as follows: D+/R+ 28, D+/R− 5, D−/R+ 5, and D−/R− 4. Valganciclovir was given for a total of 6 months posttransplant except for D−/R+ patients who received it for 12 months. Results. Five patients (12%) developed CMV disease with an average followup of 26 months. Only 2 (4.7%) developed CMV disease within six months of completing valganciclovir prophylaxis. This incidence is not significantly different from the best-reported results of CMV prophylaxis in lung transplant recipients. The remaining 3 patients developed the disease later in their course, one as late as 32 months posttransplant. The main side effects noted include leucopenia, neutropenia, and GI disturbances. However, the number of patients who had to temporarily stop or discontinue the medication (9.5%) was significantly lower than that reported in previous studies. Conclusions. Our experience suggests that low-dose valganciclovir is an effective method of prophylaxis for CMV disease in high-risk patients. It is a simple regimen that seems to have a better side effect profile and to improve patient compliance. Hargobind S. Khurana, Alison Kole, Jeremy Falk, Sara Ghandehari, Guy Soohoo, Sinan Simsir, Wen Cheng, Robert M. Kass, Jasjit Khurana, and George Chaux Copyright © 2013 Hargobind S. Khurana et al. All rights reserved. A Review of Long-Term Mechanical Circulatory Support as Destination Therapy: Evolving Paradigms for Treatment of Advanced Heart Failure Wed, 28 Nov 2012 09:53:05 +0000 Left ventricular assist devices as long-term mechanical circulatory support are increasingly utilized as an option for medically refractory advanced heart failure. Rapid advances in this field, from pulsatile paracorporeal flow pumps to now more advanced intracorporeal continuous flow devices, have led to more wide spread use of device therapy. Several trials have now confirmed the survival benefits of ventricular assist devices, not only as a method for bridging patients waiting on the transplant list, but also as an evolving paradigm of destination therapy. Significant improvements in quality of life and functional status have been reported in patients receiving these devices. Survival outcomes with this therapy continue to improve, and long term durability of newer generation devices remains yet to be discerned. Comparative data to heart transplantation remains scarce. This paper will focus on the historical development of ventricular assist device therapy for advanced heart failure, review major trials of destination therapy, and look at comparative literature in the modern era to cardiac transplantation. Ali A. Valika and William Cotts Copyright © 2013 Ali A. Valika and William Cotts. All rights reserved. MHC Disparate Resting B Cells Are Tolerogenic in the Absence of Alloantigen-Expressing Dendritic Cells Wed, 28 Nov 2012 09:17:27 +0000 Resting B cell (rB) populations have been shown to tolerize to soluble proteins and to minor-H but not to MHC alloantigens. We speculated that the reason for failing to tolerize to MHC alloantigen is that the few remaining dendritic cells (DCs) contaminating purified rB cell populations efficiently activate MHC allospecific T cells which are present at a higher frequency than T cells specific for minor-H alloantigen and soluble proteins. We established that MHC disparate rB cells are indeed tolerogenic when devoid of DC populations, as parental strain mice showed delayed skin graft rejection when infused with rB cells from mice in which MHC class I alloantigen was specifically targeted to T and B cells (CD2- transgenic mice). In contrast, treatment of parental strain mice with allogeneic rB cells purified from MHC- transgenic mice, in which is ubiquitously expressed, including DCs, induced accelerated graft rejection. We also showed that adding only 5,000 expressing DCs to CD2- rB cells abrogated the tolerogenic effect. Surprisingly, allogeneic rB cells prolonged graft survival in -primed mice. Thus, MHC disparate rB cells are tolerogenic and their failure to delay graft rejection can be explained by contaminating allogeneic DCs. Hugh I. McFarland, Kazuhide Tsuji, Karen P. Mason, and Amy S. Rosenberg Copyright © 2013 Hugh I. McFarland et al. All rights reserved. Tacrolimus Dose Modification in Hematopoietic Cell Transplant Recipients Following a Change in Therapy from Fluconazole to Voriconazole Wed, 24 Oct 2012 14:03:08 +0000 Antifungal therapy with voriconazole or fluconazole in combination with the calcineurin inhibitor tacrolimus exhibits significant CYP3A4 drug interaction potential in allogeneic hematopoietic cell transplant (HCT) recipients. The package insert for voriconazole has dosing recommendations for tacrolimus when voriconazole is started, but these do not apply to patients already receiving fluconazole therapy. The purpose of this retrospective study is to estimate appropriate dose modification of tacrolimus following a change in therapy from fluconazole to voriconazole. We performed a retrospective case-series analysis of five patients. The mean steady-state concentration/dose (C/D) ratio of tacrolimus increased from 413 (range, 255–642) to 850 (range, 670–953) following a switch from fluconazole to voriconazole (). This data represents a mean 2-fold increase in C/D ratios following the switch, indicating that the dose of tacrolimus may be most accurately reduced by approximately 50% following this switch in therapy. This provides some guidance for practitioners to estimate dose adjustments but will require close pharmacokinetic monitoring and adjustments on an individual patient basis. Anthony J. Guarascio, Douglas Slain, and Aaron Cumpston Copyright © 2013 Anthony J. Guarascio et al. All rights reserved. Double-Glide Method Using Cathereep Protective Sheet As a Substitute in Descemet's Stripping Automated Endothelial Keratoplasty Tue, 18 Sep 2012 14:38:15 +0000 Purpose. For the insertion of the donor graft in Descemet's stripping automated endothelial keratoplasty (DSAEK), the double-glide method using a Busin glide and intraocular lens (IOL) glide concomitantly has been shown to be effective. The aim of this report is to evaluate the results for the double-glide method using Cathereep (Nichiban, Tokyo, Japan), a protective sheet made of polyurethane film for medical use, as a substitute for an IOL glide. Materials and Methods. The subjects were 10 eyes of 10 patients with bullous keratopathy. The DSAEK operation was performed, and the double-glide method was used for the donor graft insertion. During the operation, an IOL glide was used for the 5 eyes, and the Cathereep protection sheet was used for the remaining 5 eyes. We trimmed approximately 5 mm wide strips from the nonadhesive area surrounding the Cathereep protection sheet. Results. The donor graft was inserted equally easily with the Cathereep protective sheet and IOL glides and improvement of visual acuity was noted in both groups significantly. A favorable postoperative course was obtained with no perioperative complications including endothelial damage. Conclusions. Cathereep protective sheet can be used as a substitute for an IOL glide for double-glide method in DSAEK. Hiroshi Toshida, Rio Honda, Asaki Matsui, Yusuke Matsuzaki, Yusuke Shimizu, Takahiko Seto, Toshihiko Ohta, and Akira Murakami Copyright © 2013 Hiroshi Toshida et al. All rights reserved. Surgical Morbidity of Simultaneous Kidney and Pancreas Transplantation: A Single-Centre Experience in the Tacrolimus Era Tue, 28 Aug 2012 10:45:56 +0000 Introduction. Simultaneous pancreas and kidney (SPK) transplantation is performed to restore normoglycaemia and renal function in patients with Type I diabetes mellitus and end-stage renal failure. We aimed to evaluate the impact of major postoperative complications to patient and graft survival outcomes. Method. Using a prospectively collected database over a 10-year period, major postoperative complications requiring return to operating theatre as well as patient and graft survival outcomes were analysed retrospectively. Results. Between January 2001 and May 2010, 165 patients underwent first-time SPK transplantation. Median age of recipients was 39.8 years (range, 16.9–53.2). Enteric drainage was used in 149 patients, and bladder drainage was used in 16. Median follow-up time was 5.2 years (range 1.1–10.3). Fifty-six patients (34%) returned to operating theatre at least once. Pancreatic allograft loss secondary to vascular thrombosis occurred in 12 patients (7%), and 2 patients (1.2%) required transplant pancreatectomy due to debilitating pancreatic enzyme leaks. At 1 and 5 years, patient survival was 98% and 94%; pancreas graft survival, 86% and 77%; kidney graft survival 96% and 89%, respectively. Conclusion. SPK is a safe and effective treatment for Type I diabetes mellitus and end-stage renal failure although surgical reintervention is required in approximately one-third of patients. Preventing vascular thrombosis remains a major challenge. Stephen E. Thwaites, Vincent W. T. Lam, Jinna Yao, Kathy Kable, Lillian Jenkins, Cheng Chen, Paul Robertson, Wayne J. Hawthorne, Brendan J. Ryan, Henry C. Pleass, and Richard D. M. Allen Copyright © 2013 Stephen E. Thwaites et al. All rights reserved.