Are kidney-pancreas transplants successful?
History of a pancreatic kidney transplant patient
I want to say in advance that the previous illness which led to my kidney failure was type I diabetes mellitus, which I tried to get under control for more than a quarter of a century.
At some point my kidneys began to slowly but surely stop working. Now I had the problem of having to couple a kidney diet with the diet of a diabetic. I succeeded more badly than well. At the beginning of 1995 my kidney parameters were so bad that my attending physician (Doz. Dr. P. Kotanko, BHB Graz, Marschallgasse) gave me the very depressing message that I would not be spared the trip to dialysis in the foreseeable future. Although I noticed my general condition getting worse and worse, my wife and I still had the hope that it might not be so soon. In autumn 1995 I had already come to terms with the fact that I was on dialysis, mainly because I was simply no longer physically resilient and I hadn't known this condition until then. At the same time, I had a shunt operated on.
Although Shrove Tuesday 1996 - a day to laugh and celebrate - I didn't feel like it that day as it was my first day of dialysis at the Brothers of Mercy Hospital. Although I had been informed about the process, I went to dialysis quite unsure, especially I did not know how I would tolerate the treatment. After the first few treatments, I noticed a significant improvement in my overall condition. I have always tolerated dialysis very well because I always tried not to drink too much so as not to gain too much weight until the next dialysis.
My wife and I had booked a week's skiing holiday for the beginning of March and since I was feeling much better again, I asked whether this vacation could be expected of me. The answer was a somewhat hesitant “yes, if you dare to do it” - but where should I go on dialysis during this time? I was able to reserve a guest dialysis place for myself in the Zell am See hospital and was more than happy about it. That was my best skiing holiday despite the dialysis every other day! It was only then that I realized that dialysis does not necessarily mean being tied to a ward, and I really started to revive. Since then I have been of the opinion that vacation and exercise go very well with simultaneous dialysis treatment and are very, very valuable and important for the psyche.
In the first half of my dialysis time, I was trained by Prim.Univ. Prof. Dr. F. Skrabal and
Doz. P. Kotanko pointed out the possibility of an organ transplant, in my case a combination of kidney and pancreas to eliminate the underlying disease (diabetes mellitus). In my opinion, the doctors informed me very precisely about the transplant and the necessary preliminary examinations, and they also pointed out that both organs were of course not functioning in advance. I was also informed about life with transplants (medication, behavior, etc.). At that time I was feeling good physically and so began a process of deliberation and weighing up with my wife. One argument for me was that nobody can say how long a dialysis treatment can be carried out without problems, which is certainly individually dependent and a second argument was that it can only get better! So I agreed and started the various preliminary examinations and minor repairs, such as the condition of the teeth. In the fall I was then at the Univ. Innsbruck Clinic registered for combined transplantation. I was asked to take a look at the ward with my wife and speak directly to a transplant surgeon about the procedure, which we did. Too much knowledge has never hurt!
Exactly one year to the day after my first dialysis, I was so successfully transplanted in Innsbruck that both organs started working immediately after the operation and no insulin or dialysis was necessary. The kidney parameters also went back very quickly to the normal range. The first week I felt reborn and as healthy as I had not for more than 25 years. But as some problems arose, "thank God" I couldn't leave the clinic as quickly as I had hoped.
And again on a day for joking and being funny, on April 1st I had an acute rejection of my transplants. I then immediately received a high dose of cortisone to stop the rejection process. A world almost collapsed for me, I had already made friends with my new life and now it has said goodbye again. The attending doctor then tried to explain to me that something like this can always happen and that all is not lost by a long way, I shouldn't give up hope yet. An exchange of my blood plasma was started immediately. After dialysis treatment, my new kidney began to function slowly again, but I never returned to the original parameters. From the fact that the kidneys slowly recovered, I was able to rebuild myself mentally and - as it actually corresponds to my nature - immediately started to think more positively again. The doctors were also pleased with this attitude. Now the wait began to see if and when the new pancreas would start working again. The wait of six weeks in total was worth it, although it was often not very easy for me. She started working again as if nothing had happened. I have already been told, however, that it is not clear how far it is damaged by the rejection.
After detailed information about the medication to be taken and their possible side effects and precise information about how I should behave in the future in the event of a cold or a temperature increase, etc., I was discharged from the clinic after exactly four months with two functioning organs, with the condition that I was myself to be found regularly for control in the hospital of the Barmherzigen Brüder in Graz, Marschallgasse.
After a few weeks of recovery, I got to know a life that I had already forgotten! It was just wonderful to be healthy except for the medication that had to be taken all the time!
Despite my euphoria, I was well aware that this state of health would not apply for the rest of my life, but at that time it was just great!
In late 1998 my Hba1C started to rise.
And again on the first of April (1999) I started injecting insulin again. Of course, I was depressed - but my kidneys functioned like the day I was discharged from the hospital - that calmed me down a bit. Again I was suggested the possibility of a new pancreatic transplant. Since I got to know life again without diabetes, I agreed again, in the hope that it would go better this time. The waiting time this time was a lot longer.
On May 28, 2002, I flew to Innsbruck for the transplant with the same high expectations as in 1997. This time everything went as it should and a month later I was back home with a new pancreatic transplant. Since then my blood sugar levels have been in the normal range!
Of course there have been some problems or illnesses over the years, but I always found help at the Merciful Brothers Hospital, no matter what time of day or night!
I would like to thank my nephrologists and internists for what I believe to be a doctor is not only a profession but also a calling, but also with the nursing staff in the hospital of the Barmherzige Brüder in Graz, Marschallgasse and with the team of Univ.Prof. Dr.R. Margreiter, Innsbruck University Hospital, thank you very much for your help and support and hope to stay with you as a transplant recipient for a long time to come.
With a transplant, the quality of life increases many times over, but one must never forget that one has to cherish and care for the organ that has been preserved.
This year, after a total of 30 years of diabetes and one year of dialysis, I can celebrate a tenth and a five-year transplant anniversary.
I hope that my two grafts will continue to work so well for a long time and I am grateful
that I live in a time when transplant surgery can do just that.
Dr Walter Hengsberger
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