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Simultaneous pancreas-kidney transplantation (SPK) is the optimal treatment for selected patients with type I diabetes mellitus (T1DM) and end-stage kidney disease, but intraoperative bleeding remains a major cause of morbidity. Methylene blue flush during back-table pancreas preparation may better help preemptively identify bleeding points and reduce complications.

A single-center, single-blinded, prospective randomized control trial was conducted at Westmead Hospital over 30 mo. Sixty participants were randomized to receive either crystalloid (n = 33) or methylene blue (MB) flush (n = 27) during pancreas preparation before implantation. The primary outcome was intraoperative bleeding.

There was no significant difference in intraoperative blood loss with the use of MB flush (433 ± 385 mL versus 588 ± 382 mL; P = 0.10). The MB group required significantly lower intraoperative blood transfusions (7% versus 27%, P = 0.032) but higher postoperative transfusions within 7 d (81% versus 58%, P = 0.038). No significant differences were observed in length of stay, reoperation rates, delayed graft function, readmission rates, graft loss, or mortality. Early graft loss and pancreatectomy were lower in the MB group (4% versus 12%) without reaching statistical significance (P = 0.206).

MB flush did not significantly reduce intraoperative blood loss but reduced intraoperative transfusion requirements, while increasing postoperative blood transfusion requirements, indicating a temporal shift in bleeding pattern. Graft outcomes were unaffected. Further studies should explore mechanisms and evaluate long-term outcomes.