Bladder-Drained Pancreas Transplantation: Urothelial Innate Defenses and Urinary Track Infection Susceptibility

Byrne, Matthew H V; Singh, Aminder; Mowbray, Catherine; Aldridge, Phillip D.; Drage, Lauren; Ali, Ased; Bates, Lucy; Hall, Judith G.

doi:10.1016/j.jss.2018.09.028

Cited by 5 publications

(4 citation statements)

References 32 publications

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“…Two recent long‐term studies reported that >40% of patients with bladder drainage require enteric conversion at some point in time 197,207 . Additionally, bladder drainage increased the rate of metabolic and urologic complications, 188,198,208–216 and did not improve immunologic outcome of either SPK 187,190‐192,196‐198,205,206,208,214,217,218 or solitary pancreas transplantations 70,171,219 …”

Section: Discussionmentioning

confidence: 99%

“…190 Two recent long-term studies reported that >40% of patients with bladder drainage require enteric conversion at some point in time. 197,207 Additionally, bladder drainage increased the rate of metabolic and urologic complications, 188,198,[208][209][210][211][212][213][214][215][216] and did not improve immunologic outcome of either SPK 187,[190][191][192][196][197][198]205,206,208,214,217,218 or solitary pancreas transplantations. 70,171,219 Duodeno-duodenostomy (vs. duodeno-jejunostomy) was not considered to clearly increase the overall rate of surgical complications after pancreas transplantation, despite higher rates of bleeding.…”

Section: 2%mentioning

confidence: 99%

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First World Consensus Conference on pancreas transplantation: Part II – recommendations

Boggi

Vistoli

Andrès

et al. 2021

American Journal of Transplantation

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Section: Discussionmentioning

confidence: 99%

Section: 2%mentioning

confidence: 99%

First World Consensus Conference on pancreas transplantation: Part II – recommendations

Boggi

Vistoli

Andrès

et al. 2021

American Journal of Transplantation

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“…This is in contrast to previous reports, where infectious complications were the main cause of morbidity and mortality after PT and the administration of broad-spectrum prophylactic antibiotics, antifungal, and antiviral agents was recommended [47,48]. These recommendations, however, are based on smaller studies with mainly bladder-drained PT, which involves a higher risk of recurrent infections and urologic complications [7,49]. In our cohort, all PTs were performed with enteric drainage, as enteric complications are rare overall [12,50] and the need for later conversion from bladder to intestinal exocrine drainage is avoided [7].…”

Section: Discussionmentioning

confidence: 86%

The Role of Late-Onset Inflammatory Markers in the Prediction of Complications and Graft Survival after Pancreas Transplantation

2023

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Background: Despite great progress in graft survival and complication rates, pronounced inflammatory responses are common after pancreas transplantation (PT). Subsequent to the first postoperative increase in inflammatory markers, we have frequently observed a second peak of C-reactive protein (CRP) and white blood cells (WBCs) following PT. This analysis is to assess the incidence and clinical relevance of late-onset increases in inflammatory markers following PT. Materials and methods: We analyzed all consecutive PTs over a 20-year period. The second peak of CRP (SCP) and WBCs (SWP) was defined as an increase >3 days after PT subsequent to a relevant initial decrease. Results: Of 116 patients, 60 (51.7%) developed SCP. SCP was not associated with pancreas graft loss or with thrombosis at discharge or at 90 days after PT (6.7% vs. 0.0%, p = 0.1; 8.3% vs. 1.8%, p = 0.2; and 15.0% vs. 3.6%, p = 0.06, respectively). Patients with SCP had more complications overall at discharge and at 90 days (85.0% vs. 50.0%, p < 0.001 and 93.3% vs. 76.8%, p = 0.02). In multivariable analysis, SCP was significantly associated with pre-transplant HbA1c (OR 2.1 (95% CI: 1.3–3.8); p = 0.005) and female gender (OR 0.03 (95% CI: 0.004–0.14); p ≤ 0.001). No significant association was found between SCP and pancreas cold ischemia time (OR 1.0 (95% CI: 1.0–1.0); p = 0.1), donor age (OR 1.01 (95% CI: 0.96–1.06); p = 0.7), recipient age (OR 0.9 (95% CI: 0.9–1.0); p = 0.1), or recipient BMI (OR 0.9 (95% CI: 0.9–1.4); p = 0.3). SWP did not differ in patients with or without SCP (p = 0.07) and there was no correlation with pancreas graft loss or relaparotomy (p = 0.3 and p = 0.6, respectively). Insulin-free graft survival after 1, 5, and 10 years did not differ between patients with SCP and those without SCP (95.0%, 90.2%, 90.2% vs. 96.1%, 91.2%, 88.7%, respectively; p = 0.964). Conclusion: Late-onset inflammatory reactions are frequently seen in PT and are correlated with higher overall complication rates. They are not correlated, however, with graft-specific complications or insulin-free graft survival.

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“…A single pedicle of donor iliac artery bifurcation (Y‐graft) is then anastomosed to the common iliac artery. Donor duodenum can be anastomosed to recipient's small bowel or bladder to create drainage for exocrine secretions 58,59 . If kidney transplantation is also performed, this is typically placed in left iliac fossa.…”

Section: Transplantation Options For Diabetic Kidney Diseasementioning

confidence: 99%

Diabetic kidney disease and transplantation options

2021

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Diabetes is the leading cause of chronic kidney disease worldwide and associated with significant morbidity and mortality. Despite advances in treatment options for diabetic kidney disease, a substantial proportion of patients still progress to end‐stage renal disease. While not without its own risk and complications, transplantation remains the best modality of renal replacement therapy in terms of patient outcome and cost‐effectiveness when compared to dialysis. This article reviews diabetic kidney disease with a focus on options for transplantation including kidney, pancreas and islet cell transplantation. Copyright © 2021 John Wiley & Sons.

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Bladder-Drained Pancreas Transplantation: Urothelial Innate Defenses and Urinary Track Infection Susceptibility

Abstract: Conclusions: These in vivo and in vitro data suggest that BD pancreatic exocrine secretions inactivate the bladder innate defenses, which facilitate UPEC growth and underpins the increased susceptibility of patients who underwent BD pancreas transplantation to rUTIs.

Cited by 5 publications

References 32 publications

First World Consensus Conference on pancreas transplantation: Part II – recommendations

First World Consensus Conference on pancreas transplantation: Part II – recommendations

The Role of Late-Onset Inflammatory Markers in the Prediction of Complications and Graft Survival after Pancreas Transplantation

Diabetic kidney disease and transplantation options

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