What happens to the kidney in an SPK transplant when the pancreas fails due to a technical complication?

Abstract

We examined a group of SPK recipients that had early (<90 d post-transplant) pancreas graft failure caused by a technical complication, and looked at outcomes of the kidney graft in these recipients. Of 289 SPK transplants, 36 (12.5%) had early pancreas graft failure because of a technical complication: thrombosis (n = 16), leak (n = 5), infection (n = 14), and pancreatitis (n = 1). Once the pancreas was lost, there was a high incidence of subsequent kidney graft failure. Kidney graft survival in these 36 recipients was 71.4% at one yr and 59.5% at three yr, significantly inferior compared to recipients that did not have early failure of the pancreas (86% at one yr and 82% at three yr, p < 0.001). Of the 36 recipients with early pancreas loss, 18 have gone on to failure of the kidney graft. Causes included thrombosis (n = 3), infection (n = 1), death with function (n = 6), chronic rejection (n = 4), ischemia (n = 1), and other (n = 3). Of the 18 kidney graft failures, nine occurred within three months after loss of the pancreas graft, usually either because of graft thrombosis, or patient death (usually from systemic sepsis). Multivariate analysis showed technical failure of the pancreas to be the most significant risk factor for kidney graft loss (HR = 2.08, p = 0.006).

Twelve-Month Pancreas Graft Function Significantly Influences Survival Following Simultaneous Pancreas-Kidney Transplantation

“…Other studies have shown that pancreas graft function contributes to improved patient and kidney graft survival, but fail to quantify this degree of benefit (or cost) compared with LD KA. SPK recipients without pancreas function at 90 d(28) or 12 mo (29) posttransplant suffer worse kidney (28) and patient (29) survival when compared with SPK recipients with preserved pancreas function. Notably, these studies were hindered by the single-center nature of one trial (28) and the outcomes reported from an earlier era (1987 to 1996) in the other (29).…”

Influence of Surgical Complications on Kidney Graft Survival in Recipients of Simultaneous Pancreas Kidney Transplantation

“…Previous studies have shown that SPKT recipients with early technical failure of the pancreas have significantly inferior kidney graft survival rates compared to those who did not (59.5% vs 82% at three years, P < .001) [7]. Contrary to this, Banga [8] reveals that longterm kidney survival remains unaffected in patients who experience early re-laparotomy compared to those who did not (82% versus 83%, at 5 years P ¼ .412).…”

“…Several investigators have described the negative influence with postoperative complications in SPKT forecast, although most of them focus on pancreas graft prognosis, with which the majority of complications are associated [6]. There is little and controversial literature about the influence of these complications in graft kidney medium and long-term prognosis [7,8].…”

The Role of Kidney-Pancreas Transplantation in Diabetic Kidney Disease

“…The SPK(P+) cohort had significantly better estimated survival throughout the following 7 years (88.6%) than the remaining three groups, including the LDKA group (80.0%), which had a nonstatistically better survival advantage over those SPK recipients who had lost function in the first year (SPK,P-; 73.9%). This point was reiterated in a large single-center analysis that demonstrated that in the 12% of SPK recipients who had early loss of pancreas function (within 90 days), patient and kidney graft survival were significantly worse than SPK recipients with early function of the pancreas [20]. …”