Leiden University Scholarly Publications

Persistent URL of this record https://hdl.handle.net/1887/122967

In Collections

This item can be found in the following collections:

Kovacs, D.A.; Braat, A.E.; Huurman, V.A.L.; Baranski, A.G. (2019)

Simultaneous Pancreas-Kidney Transplant After Bricker Loop Urinary Diversion: A Case Report

Article / Letter to editor
Simultaneous pancreas-kidney transplant is the ultimate therapy for patients who have uncontrolled and complicated type 1 diabetes mellitus with end-stage renal disease. The combined pancreas transplant provides a euglycemic milieu for the kidney and protects it from recurrence of diabetic complications. Our patient, a 41-year-old woman with end-stage diabetic nephropathy and history of multiple abdominal surgeries (ovarian cyst fenestration, adnexal extirpation, abdominal wall reconstruction), including urinary diversion (Bricker loop, above double J stent), underwent simultaneous pancreas-kidney transplant. After reperfusion, the kidney had immediate function and creatinine levels dropped to normal levels during the early postoperative period (creatinine of 102 mu mol/L, estimated glomerular filtration rate of 52 mL/min/1.73 m(2)) and remained stable during follow-up. Serum glucose levels dropped to within normal ranges postoperatively and remained so during follow-up. The...Show moreSimultaneous pancreas-kidney transplant is the ultimate therapy for patients who have uncontrolled and complicated type 1 diabetes mellitus with end-stage renal disease. The combined pancreas transplant provides a euglycemic milieu for the kidney and protects it from recurrence of diabetic complications. Our patient, a 41-year-old woman with end-stage diabetic nephropathy and history of multiple abdominal surgeries (ovarian cyst fenestration, adnexal extirpation, abdominal wall reconstruction), including urinary diversion (Bricker loop, above double J stent), underwent simultaneous pancreas-kidney transplant. After reperfusion, the kidney had immediate function and creatinine levels dropped to normal levels during the early postoperative period (creatinine of 102 mu mol/L, estimated glomerular filtration rate of 52 mL/min/1.73 m(2)) and remained stable during follow-up. Serum glucose levels dropped to within normal ranges postoperatively and remained so during follow-up. The postoperative course was complicated by hydronephrosis due to transient edema of the anastomosis of the ureter to the Bricker loop, after early incidental removal of the double J catheter. This was successfully treated with a temporary percutaneous nephrostomy. Multiple previous surgeries, including a Bricker deviation, may not be a definitive contraindication for simultaneous pancreas-kidney transplant. In selected cases, special considerations may lead to a successful procedure providing better quality of life and life expectancy, even for patients with multiple comorbidities.Show less
Diabetes mellitus
Diabetic nephropathy
End-stage renal disease
All authors
Kovacs, D.A.; Braat, A.E.; Huurman, V.A.L.; Baranski, A.G.
Date
2019-10-01
Journal
Experimental and Clinical Transplantation
Volume
17
Issue
5
Pages
685 - 687
DOI
doi:10.6002/ect.2018.0100