Simultaneous pancreas-kidney transplantation in a patient with type 1 diabetes — a case study

Abstract

Simultaneous pancreas-kidney transplantation (SPKTx) is performed in end-stage renal disease in patients with type 1 diabetes. A recipient is usually a dialysed patient. The paper presents a description of a 34-year-old female patient in the early period after simultaneous pancreas-kidney transplantation from a deceased donor with the essential elements of nursing care. The patient in the end-stage renal disease phase due to diabetic nephropathy, type 1 diabetes diagnosed when the patient was 9 years old. Since 2013, treated with repeated haemodialysis with access via a Brescia fistula, existing micro- and macrovascular complications. The patient qualified for SPKTx, without any contraindications in the immediate preoperative period. Quadruple immunosuppression with thymoglobulin induction. In the postoperative period, biochemical features of acute pancreatitis were observed, parenteral nutrition and a strict diet were used. Once the diastase level had been normalised, oral nutrition was reinstated. The function of the transplanted kidney with a urine volume of 3000–4000 mL, a creatinine concentration of 0.75 mg/dL. The patient did not need exogenous insulin supply after the surgery, the blood glucose level was within the range of 87–175 mg/dL. After the surgery the patient’s vital signs had to be strictly monitored, particularly the level of blood glucose, diuresis, fluid balance, laboratory tests were performed and analysed, Doppler ultrasound tests of the transplanted organs were performed, pharmacotherapy was used, including immunosuppressive drugs, analgesic management and an appropriate fluid therapy.