One Thousand Simultaneous Pancreas-Kidney Transplants at a Single Center With 22-Year Follow-Up

Sollinger, Hans W.; Odorico, Jon S.; Becker, Yolanda T.; D’Alessandro, Anthony M.; Pirsch, John D.

doi:10.1097/sla.0b013e3181b76d2b

Cited by 286 publications

(266 citation statements)

References 20 publications

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“…Of note, these patient survival rates were similar to those after primary pancreas transplantation4, 22, 28. Interestingly, recipients of multiple pancreas retransplantations achieved even better survival.…”

Section: Discussionsupporting

confidence: 62%

Outcomes of pancreas retransplantation in patients with pancreas graft failure

Gasteiger

Cardini

Göbel

et al. 2018

British Journal of Surgery

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BackgroundPancreas retransplantation is still a controversial option after loss of a pancreatic graft. This article describes the experience of pancreas retransplantation at a high‐volume centre.MethodsThis was a retrospective observational study of all pancreas retransplantations performed in a single centre between 1997 and 2013. Pancreatic graft loss was defined by the return to insulin dependence. Risk factors for graft loss as well as patient and graft survival were analysed using logistic and time‐to‐event regression models.ResultsOf 409 pancreas transplantations undertaken, 52 (12·7 per cent) were identified as pancreas retransplantations. After a median follow‐up of 65·0 (range 0·8–174·3) months, 1‐ and 5‐year graft survival rates were 79 and 69 per cent respectively, and 1‐ and 5‐year patient survival rates were 96 and 89 per cent. During the entire follow‐up, 22 grafts (42 per cent) were lost. Patient survival was not associated with any of the donor‐ or recipient‐related factors investigated. Five‐year graft survival was better after simultaneous kidney–pancreas retransplantation than pancreas retransplantation alone: 80 per cent (16 of 20) versus 63 per cent (20 of 32) (P = 0·226). Acute rejection (odds ratio 4·49, 95 per cent c.i. 1·59 to 12·68; P = 0·005) and early surgical complications (OR 3·29, 1·09 to 9·99, P = 0·035) were identified as factors with an independent negative effect on graft survival.ConclusionPancreas retransplantation may be considered for patients whose previous graft has failed.

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Section: Discussionsupporting

confidence: 62%

Outcomes of pancreas retransplantation in patients with pancreas graft failure

Gasteiger

Cardini

Göbel

et al. 2018

British Journal of Surgery

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“…1 In fact, our 9-year survival data-93% patient, 90% kidney, and 79% pancreaswere good when compared with other published 10-year results. 1 Two important recently published papers have concluded that SPKT provides a significant extension to patient life, 1 namely 10 years longer than that of KTA from a deceased donors. 5 Our perception is that SPKT patients are really difficult to manage not only in the early period, but also in follow-up.…”

Section: Discussionsupporting

confidence: 56%

“…We observed the same causes for surgical reinterventions-infection, bleeding, and enzyme leak-as previously reported for enteric-drained patients. 1 The total length of hospital stay and intensive care residence were directly related to the presence of important complications: patients reoperated due to thrombosis, bleeding, pancreatic leak, or infection; or even patients without surgical reinterventions but who displayed relevant bleeding or infection. These patients also had an increased rate of graft loss and death.…”

Section: Discussionmentioning

confidence: 99%

Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-up

Martins

Henriques

Dias

et al. 2010

Transplantation Proceedings

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Over 9 years, we have performed 93 simultaneous pancreas-kidney transplants (SPKT). The morbidity of this procedure is high compared with kidney transplantation alone; readmissions are frequent and costs are higher. Herein we have presented the complications during follow-up of these 93 patients. Their mean age was 34 Ϯ 6 years and prior dialysis time was 32 Ϯ 25 months. The median hospital stay on the first admission for the transplant procedure was 22 days, including 2 days in the intensive care unit. Bleeding, thrombosis, and infection were the most frequent reasons for prolonged hospitalization. Thirty patients underwent Ն1 surgical reinterventions. Incidence of acute rejection episodes was 11.8%. After discharge, 74.2% of the patients had 197 readmission episodes with infection being the main cause, urinary tract infections, the most frequent; however, systemic viral and fungal infections required the longest readmission periods. The need for surgical interventions, graft dysfunction, and vascular problems were the remaining causes of readmission. At the end of follow-up, 87 patients were alive, 86 with well-functioning kidneys and 74 with normal functioning pancreata. Global survival rates for patient, kidney, and pancreas were 96%, 95%, and 81% at 1-year; 93%, 90%, and 79% at 5-years; and 93%, 90% and 79% at 9-years. Although pancreas-kidney transplant patients are complex presenting many management difficulties, our overall results represent a positive stimulus for diabetic patients. S imultaneous pancreas-kidney transplantation (SPKT)display greater morbidity, length of admission, and number of complications when compared to kidney transplantation alone (KTA), leading to higher costs. However, SPKT remains the best treatment option for good longterm results among type 1 diabetic patients with chronic kidney failure. A recently published review of 1000 SPKT from a single center 1 reinforced this position statement of the American Diabetes Association. We have presented herein the results of our SPKT program, including the rate and type of complications, causes of surgical reinterventions, and readmission episodes after the initial discharge. PATIENTS AND METHODSFrom May 2000 to May 2009, we performed 93 SPKT always using enteric diversion and vascular anastomoses to the systemic circulation. Immunosuppression included antithymocyte globulin (ATG) tacrolimus, mycophenolate mofetil (MMF), and steroids. After the 6th month, it was our policy to progressively taper steroids to complete withdrawal whenever possible. Infection prophylaxis comprised vancomycin, fluconazole, and a third-generation cephalosporin in the first days, with contrimoxazole and valgancyclovir thereafter. We also prescribed aspirin and low-molecularweight heparin as soon as possible after surgery, if there were no bleeding complications. RESULTSThe mean age of the 93 patients was 34 Ϯ 6 years with a 23 Ϯ 5.5 years, duration of diabetes. They had been on dialysis for 32 Ϯ 25 months excepting 4 who were grafted preemptively. Twenty...

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“…The presence of a functioning pancreas graft improved survival by 20% at 8 years (Reddy KS, 2003). Patient survival is not statistically different according to the type of exocrine drainage (BD vs. ED), but quality of life is better and overall complications is less when BD is used (Sollinger HW, et al, 2009). Despite the improved survival, the most common type of death in these patients is death with a functioning graft and cardiovascular morbidity remains a major contributor to patient outcome in these patients (Sollinger HW, et al, 2009 (Sollinger et al, 2009).…”

Section: Long Term Results Of Pancreas Transplantationmentioning

confidence: 92%