Introduction: Simultaneous pancreas-kidney transplantation (SPK)  remains the gold-standard therapy for patients with insulin-dependent diabetes mellitus(DM) and end-stage renal disease. However, the growing gap between organ donors and recipients continues due to the shortage of "ideal pancreas donors." The lower age/weight limit for pancreas donors is not clearly established, causing many transplant centres to hesitate in using pancreas grafts from pediatric donors. This reluctance stems from concerns about insufficient islet mass and a heightened risk of allograft thrombosis in the small, technically demanding pancreas, even though recipient and graft survival outcomes are comparable to those from adult donors.
Method: We present three instances of SPK from extremely young pediatric brain-dead donors (EYPD) (under five years of age and weighing less than 15kg) carried out between December 2021 and September 2022. Criteria for accepting EYPD include no evident trauma to graft pancreas without aberrant anatomy.
Results: Table-1 displays donors' and recipients' demographics, operative details, and transplant features. The same transplant surgeon team conducted all three SPK procedures. The kidney was positioned in the left iliac fossa, while the pancreas from the same donor was placed in the right iliac fossa. Enteric drainage was carried out in all instances. Immunosuppression consisted of anti-thymocyte globulin induction (ATG) (1mg/kg for three days) along with a triple-drug regimen [tacrolimus (trough level 10-12ng), mycophenolate mofetil (1.5gm/day), and prednisolone (0.4mg/kg/day)]. Antimicrobial and anticoagulant prophylaxis were administered according to the institution's protocol. All three SPK recipients attained euglycemia immediately after transplantation without needing insulin and had a normal resistive index (0.6-0.7) on graft doppler during their hospital stay. No recipients experienced graft pancreatitis, thrombosis, rejection, or required reexploration. One SPK recipient contracted human parvovirus B-19 infection during their hospital stay and was readmitted for blood transfusion and IVIG therapy. Another patient's discharge was delayed due to a COVID-19 infection.
Conclusion: Employing EYPD resulted in comparable short-term outcomes to those of ideal pancreas donors, and recognizing EYPD as ideal donors could help alleviate the increasing organ scarcity.