Ipsilateral simultaneous pancreas-kidney transplantation(iSPK) is an attractive surgical strategy searching to reduce operative time and preserve the left iliac fossa for an eventual future transplant. Tradionally, pancreas is placed and reperfused first followed by kidney transplant. The aim of the study was to analyze a technical variant of iSPK.

A retrospective analysis was performed of 33 iSPK with simultaneous pancreas and kidney reperfusion from 2019 to 2021. Briefly, a wider cranio-caudal dissection of right iliac fossa was performed intended to fit both pancreas(more cranial) and kidney grafts. All the vascular anastomosis(pancreas vein and artery, kidney vein and artery)  were performed first and next pancreas reperfusion was released, followed by a short hemostasis. After a few minutes kidney was also reperfused. Sequentially, exocrine drainage and uretheral anastomosis were performed. All PT were systemic(cava)-enteric drained, either by duodenal drainage or duodenojejunostomy.

Donor and recipient age was 28.3(18-42) and 35.8(23-51) years and cause of donor death was cerebrovascular in 39% of cases. Mean surgical time was 322 min(235-420 min), pancreas and kidney cold ischemia time was, respectively, 519min(410-765min) and 526min(415-771min) and time interval between kidney and pancreas reperfusion was 7.3 min(1-65min). Blood transfusion was required in 4(12.1%) and kidney DGF occurred in 16(48.4%) patients. 1-year actuarial patient, kidney and pancreas graft survival was respectively 88%, 82% and 85% ,mean hospital stay was 8.0 days(4-30) and reoperations occurred in 7(21%) patients.

iSPK with simultaneous pancreas and kidney reperfusion is a variant technique of traditional iSPK that potentially shortens operative time, kidney cold ischemia time and also can minimize the time interval between pancreas and kidney reperfusion to only a few minutes. This initial series showed outcomes at least as good as other SPK techniques.