Decreased wound complications of combined kidney/pancreas transplants using intraabdominal pancreas graft placement

The increased success of combined kidney/pancreas transplantation due to improved immunosuppression and increasing sophistication of harvest and transplant techniques has allowed a more systematic evaluation of the outcomes of the procedure. We were impressed with the early morbidity associated with wound complications in our initial series of combined kidney/pancreas transplants. We evaluated the first 25 patients who received combined kidney/pancreas transplants at our institution. All patients received whole pancreas grafts with a duodenal segment with bladder drainage and an identical immunosuppressive protocol. Group I included 10 patients which had bilateral flank incisions with the pancreas always placed on the right side. Group II included 15 patients who had a midline incision with intraabdominal placement of the pancreas. Actuarial graft survival at 1 year was similar between the two groups at 88%. Wound complications were significantly decreased in Group II vs. Group I with 60% of patients in Group I having significant wound complications. Only 1 patient in Group II had a wound complication and this was related to a bladder leak. We conclude that intraabdominal placement of the graft through a midline incision substantially decreases morbidity associated with wound complications in a combined kidney/pancreas transplant setting.