Influence of donor and recipient sex on outcomes following simultaneous pancreas–kidney transplantation in the new millennium: Single‐center experience and review of the literature

Coffman, David; Jay, Colleen L.; Sharda, B; Garner, Matthew; Farney, Alan C.; Orlando, Giuseppe; Reeves‐Daniel, Amber; Mena-Gutierrez, Alejandra; Sakhovskaya, Natalia; Stratta, Robert J.

doi:10.1111/ctr.14864

Cited by 7 publications

(5 citation statements)

References 28 publications

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“…On the other hand, female gender was protective for the incidence of SCP. This is interesting, as previous data failed to show a relevant impact of recipient gender on outcome after SPK [38,39]. Importantly, we found no association between SCP and donor age, recipient age, or the duration of cold ischemia in this cohort.…”

Section: Discussionsupporting

confidence: 50%

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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Section: Discussionsupporting

confidence: 50%

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

2023

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“…Participants were stratified according to donor (D) sex, recipient (R) sex, 4 D/R sex categories, and D/R sex-matched vs mismatched groups. 18 This study found that D-male patients had a higher kidney graft survival ( P = .002) and patient survival rate ( P = .08) compared to the D-female patients. There was no difference in pancreas graft survival between the D-male and D-female groups ( P = .23).…”

Section: Pancreatic Transplantationmentioning

confidence: 60%

“…Overall, the D-female groups demonstrated a higher risk of kidney graft failure (HR 2.12, 1.26-3.57, P = .005), regardless of recipient sex. Survival rates appear higher in the D-male/R-male categories and lower in D-female/R-male categories, 18 but more work needs to be done to corroborate these findings.…”

Section: Pancreatic Transplantationmentioning

confidence: 97%

Abdominal Organ Transplantation: Noteworthy Literature in 2022

Nolasco

Igwe

Sakai

2023

Semin Cardiothorac Vasc Anesth

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This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.

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“…Our study showed that a female recipient had an increased baseline of systemic arterial and renal venous D-loop. Several studies have demonstrated that biological sex differences between donor and recipient impacts graft outcome [27][28][29]. In addition, it is known that, in general, women have significantly higher mitochondria-related biomarkers, such as respiration and ATP-content, which has been demonstrated in multiple organs and study models [30,31].…”

Section: Discussionmentioning

confidence: 99%

Peri-Operative Kinetics of Plasma Mitochondrial DNA Levels during Living Donor Kidney Transplantation

Kroneisl,

Spraakman,

Koomen

et al. 2023

IJMS

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During ischemia and reperfusion injury (IRI), mitochondria may release mitochondrial DNA (mtDNA). mtDNA can serve as a propagator of further injury but in specific settings has anti-inflammatory capacities as well. Therefore, the aim of this study was to study the perioperative dynamics of plasma mtDNA during living donor kidney transplantation (LDKT) and its potential as a marker of graft outcome. Fifty-six donor–recipient couples from the Volatile Anesthetic Protection of Renal Transplants-1 (VAPOR-1) trial were included. Systemic venous, systemic arterial, and renal venous samples were taken at multiple timepoints during and after LDKT. Levels of mtDNA genes changed over time and between vascular compartments. Several donor, recipient, and transplantation-related variables significantly explained the course of mtDNA genes over time. mtDNA genes predicted 1-month and 24-month estimated glomerular filtration rate (eGFR) and acute rejection episodes in the two-year follow-up period. To conclude, mtDNA is released in plasma during the process of LDKT, either from the kidney or from the whole body in response to transplantation. While circulating mtDNA levels positively and negatively predict post-transplantation outcomes, the exact mechanisms and difference between mtDNA genes are not yet understood and need further exploration.

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Influence of donor and recipient sex on outcomes following simultaneous pancreas–kidney transplantation in the new millennium: Single‐center experience and review of the literature

Cited by 7 publications

References 28 publications

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

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

Abdominal Organ Transplantation: Noteworthy Literature in 2022

Peri-Operative Kinetics of Plasma Mitochondrial DNA Levels during Living Donor Kidney Transplantation

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