Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft

Hau, Hans-Michael; Jahn, Nora; Brunotte, Maximilian; Lederer, Andri; Sucher, Elisabeth; Rasche, Franz Maximilian; Seehofer, Daniel; Sucher, Robert

doi:10.1186/s12902-020-0506-9

Cited by 33 publications

(70 citation statements)

References 42 publications

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“…The procurement and transplantation of pancreatic and kidney allografts were performed according to international standard and guidelines, as previously described [ 31 – 37 ]. The standard immunosuppression protocol at our center consisted of an induction therapy followed by triple maintenance medicamentous therapy, as described previously [ 36 , 37 ].…”

Section: Methodsmentioning

confidence: 99%

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Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

et al. 2021

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Background Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients. Methods Medical data (2000–2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors. Results Among 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI 1.00–8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24–14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76–4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI 1.19–7.04), p = 0.019). Conclusions Pre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.

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Section: Methodsmentioning

confidence: 99%

“…Note: Data from our prospectively maintained database have been previously published [ 36 , 37 ]. However, these publications addressed different scientific topics and comprised different subsets of patients.…”

Section: Methodsmentioning

confidence: 99%

Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

et al. 2021

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“…The procurement and transplantation of pancreatic and kidney allografts were performed according to international standard and guidelines, as previously described [31][32][33][34][35][36][37]. The standard immunosuppression protocol at our center consisted of an induction therapy followed by triple maintenance medicamentous therapy, as described previously [36,37].…”

Section: Surgical Techniques/immunosuppressionmentioning

confidence: 99%

“…Data from our prospectively maintained database have been previously published [36,37]. However, these publications addressed different scienti c topics and comprised different subsets of patients.…”

Section: Notementioning

confidence: 99%

Pre-operative ankle–brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

Hau

Jahn

Brunotte

et al. 2021

Preprint

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Background: Patients with insulin-dependent diabetes mellitus type 1 (IDDM1) and end-stage kidney disease (ESKD) undergoing simultaneous pancreas kidney transplantation (SPKT) are a population with diffuse atherosclerosis and elevated risk of cardio- and cerebrovascular morbidity and mortality. We aimed to investigate the feasibility of preoperative screening for peripheral arterial disease (PAD), specifically ankle-brachial index (ABI) testing, to predict peri- and postoperative outcomes in SPKT recipients. Methods: Medical data (2000–2016) from all patients with IDDM and ESKD undergoing SPKT at our transplant center were retrospectively analyzed. The correlation between PAD (defined by an abnormal ABI before SPKT and graft failure and mortality rates as primary end points, and the occurrence of acute myocardial infarction, cerebrovascular and peripheral vascular complications as secondary end points were investigated after adjustment for known cardiovascular risk factors.Results: Among 101 SPKT recipients in our transplant population who underwent structured physiological arterial studies, 17 patients (17%) were diagnosed with PAD before transplantation. PAD, as defined by a low ABI index, was an independent and significant predictor of death (HR, 2.99 (95% CI, 1.00-8.87), p = 0.049) and pancreas graft failure (HR, 4.3 (95% CI 1.24-14.91), p = 0.022). No significant differences were observed for kidney graft failure (HR 1.85 (95% CI 0.76-4.50), p = 0.178). In terms of the secondary outcomes, patients with PAD were more likely to have myocardial infarction, stroke, limb ischemia, gangrene or amputation (HR, 2.90 (95% CI, 1.19-7.04), p = 0.019).Conclusions: Pre-transplant screening for PAD and cardiovascular risk factors with non-invasive ABI testing may help to reduce perioperative complications in high-risk patients. Future research on long-term outcomes might provide more in depth insights in optimal treatment strategies for PAD among SPKT recipients.

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“… 5 , 6 Further, the patient population seeking SPKT is evolving, as improvements in diabetes care, advanced insulin delivery technologies, and delayed CKD progression have resulted in an older population living with prevalent disease and an expansion of SPKT to selected patients with type 2 diabetes. 7 - 9 The average age of SPKT recipients in 2017 was 43 years, compared with 38 years in 1995. 10 In 2018, 26.7% of US SPKT candidates and 23.1% of recipients were aged older than 50 years.…”

Section: Introductionmentioning

confidence: 99%

Impact of Functional Status on Outcomes of Simultaneous Pancreas-kidney Transplantation: Risks and Opportunities for Patient Benefit

Lentine

Alhamad

Cheungpasitporn

et al. 2020

Transplantation Direct

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Background. The impact of functional status on survival among simultaneous pancreas-kidney transplant (SPKT) candidates and recipients is not well described. Methods. We examined national Scientific Registry of Transplant Recipients (SRTR) data for patients listed for SPKT in the United States (2006–2019). Functional status was categorized by center-reported Karnofsky Performance Score (KPS). We used Cox regression to quantify associations of KPS at listing and transplant with subsequent patient survival, adjusted for baseline patient and transplant factors (adjusted hazard ratio, 95% LCLaHR95%UCL). We also explored time-dependent associations of SPKT with survival risk after listing compared with continued waiting in each functional status group. Results. KPS distributions among candidates (N = 16 822) and recipients (N = 10 316), respectively, were normal (KPS 80–100), 62.0% and 57.8%; capable of self-care (KPS 70), 23.5% and 24.7%; requires assistance (KPS 50–60), 12.4% and 14.2%; and disabled (KPS 10–40), 2.1% and 3.3%. There was a graded increase in mortality after listing and after transplant with lower functional levels. Compared with normal functioning, mortality after SPKT rose progressively for patients capable of self-care (aHR, 1.001.181.41), requiring assistance (aHR, 1.061.311.60), and disabled (aHR, 1.101.552.19). In time-dependent regression, compared with waiting, SPKT was associated with 2-fold mortality risk within 30 days of transplant. However, beyond 30 days, SPKT was associated with reduced mortality, from 52% for disabled patients (aHR, 0.260.480.88) to 70% for patients with normal functioning (aHR, 0.260.300.34). Conclusions. While lower functional status is associated with increased mortality risk among SPKT candidates and recipients, SPKT can provide long-term survival benefit across functional status levels in those selected for transplant.

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Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft

Cited by 33 publications

References 42 publications

Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

Pre-operative ankle-brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

Pre-operative ankle–brachial index for cardiovascular risk assessment in simultaneous pancreas–kidney transplant recipients: a simple and elegant strategy!

Impact of Functional Status on Outcomes of Simultaneous Pancreas-kidney Transplantation: Risks and Opportunities for Patient Benefit

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