Influence of donor- and recipient-specific factors on the postoperative course after combined pancreas–kidney transplantation

Fellmer, Peter; Pascher, Andreas; Kahl, Andreas; Ulrich, Frank; Lanzenberger, Katharina; Schnell, Konstanze; Jonas, Sven; Tullius, Stefan G.; Neuhaus, P.; Pratschke, Johann

doi:10.1007/s00423-009-0552-2

Cited by 34 publications

(28 citation statements)

References 30 publications

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“…Consistent with other studies, it was found that the most numerous and serious complications were related to pancreatic graft [5,16,22,23]. In contrast to other studies, the lethal complications related to pancreatic graft (grade IVB) but not the technical failure was used as a analysed factor in the multivariate model.…”

Section: Discussionsupporting

confidence: 74%

“…employed for SPKTx [18,19]. Using this scale, it was easily shown that graft thrombosis or pancreatitis did not always lead to graft loss [16,20,21]. Thus, we believed that this methodological approach provided broader insight regarding the underlying pathology than simply assessing pancreatic graft technical failure.…”

Section: Discussionmentioning

confidence: 99%

“…Fellmer et al approached to idea of Clavien scale. However, he distinguished only surgical complications which required surgical or radiological interventions [16].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Multivariate Analysis of Complications After Simultaneous Pancreas and Kidney Transplantation

Grochowiecki

Gałązka

Madej

et al. 2014

Transplantation Proceedings

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

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Multivariate Analysis of Complications After Simultaneous Pancreas and Kidney Transplantation

Grochowiecki

Gałązka

Madej

et al. 2014

Transplantation Proceedings

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“…Graft pancreatitis arising from ischemia reperfusion injury is a major contributing factor to many of these complications and may result in peri-pancreatic fluid collections (7), vascular thrombosis (8) and bleeding necessitating further surgery, in addition to the risk of graft loss or recipient death. Factors thought to increase the risk of graft pancreatitis include increased cold preservation time (9), donor obesity (8,10) and donor age (10,11).…”

Section: Introductionmentioning

confidence: 99%

Use of Ex Vivo Normothermic Perfusion for Quality Assessment of Discarded Human Donor Pancreases

Barlow

Hamed

Mallon

et al. 2015

American Journal of Transplantation

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A significant number of pancreases procured for transplantation are deemed unsuitable due to concerns about graft quality and the associated risk of complications. However, this decision is subjective and some declined grafts may be suitable for transplantation. Ex vivo normothermic perfusion (EVNP) prior to transplantation may allow a more objective assessment of graft quality and reduce discard rates. We report ex vivo normothermic perfusion of human pancreases procured but declined for transplantation, with ABO‐compatible warm oxygenated packed red blood cells for 1–2 h. Five declined human pancreases were assessed using this technique after a median cold ischemia time of 13 h 19 min. One pancreas, with cold ischemia over 30 h, did not appear viable and was excluded. In the remaining pancreases, blood flow and pH were maintained throughout perfusion. Insulin secretion was observed in all four pancreases, but was lowest in an older donation after cardiac death pancreas. Amylase levels were highest in a gland with significant fat infiltration. This is the first study to assess the perfusion, injury, as measured by amylase, and exocrine function of human pancreases using EVNP and demonstrates the feasibility of the approach, although further refinements are required.

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“…There are many studies reporting recipient risk factors that affect graft survival and complications after pancreas transplants. 25,26 Conversely, donor factors that have a bearing on transplant outcomes have not been well described and are restrictive among all performed organ transplants. 2,[27][28] We contend that the most important determinant of pancreas suitability is inspection of the organ by an experienced pancreas transplant surgeon.…”

Section: Discussionmentioning

confidence: 99%

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2014

Exp Clin Transplant

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Objectives: Because of the shortage of available organs for transplants, graft allocation polices have been modified recently. This report deals with the effect of using organs after rescue allocation for pancreas transplant in a single center in the Eurotransplant Region to possibly expand the donor pool. Materials and Methods: A retrospective analysis was performed. Between 2007 and 2010, 31 pancreas transplants were performed at the University Hospital of Leipzig, in Leipzig, Germany. Among these, 7 cases used rescue organs. These organs had been officially offered to, but rejected by, at least 3 consecutive transplant centers. Donor/recipient and clinical/laboratory transplant/posttransplant outcomes from patients receiving rescue organs were collected and were compared with organs from conventional donors. Results: Mean donor age was greater in the rescue organ group than in the conventional donor group (28.3 ± 10.7 y vs 23.0 ± 12.5 y). During follow-up (2.3 ± 0.6 y rescue organ group vs 3.9 ± 1.2 y conventional donor group), patient, kidney, and pancreas graft survival rates were 85% in all 3 categories in the rescue organ group, whereas outcomes for conventional donors were 88%, 85%, and 83%. Incidences of pancreatic graft thrombosis, delayed graft function, acute and late rejection episodes (eg, perioperative complications) were comparable between groups. No differences existed between mean serum urea levels and mean HbA1c levels between groups 2 years after transplant. Whereas 2 years after surgery, mean serum creatinine levels (rescue organ group, 78.8 ± 21.0 μmol/L vs 114.3 ± 28.4 μmol/L in the conventional donor group) showed significant differences between groups. Conclusions: Results are promising. Further prospective studies are warranted to evaluate routine transplant of organs after rescue allocation.

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Influence of donor- and recipient-specific factors on the postoperative course after combined pancreas–kidney transplantation

Cited by 34 publications

References 30 publications

Multivariate Analysis of Complications After Simultaneous Pancreas and Kidney Transplantation

Multivariate Analysis of Complications After Simultaneous Pancreas and Kidney Transplantation

Use of Ex Vivo Normothermic Perfusion for Quality Assessment of Discarded Human Donor Pancreases

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