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Coffman D, Jay CL, Sharda B, Garner M, Farney AC, Orlando G, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Stratta R, Stratta RJ. 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. Clin Transplant 2023; 37:e14864. [PMID: 36399473 PMCID: PMC10078322 DOI: 10.1111/ctr.14864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/28/2022] [Accepted: 11/07/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The influence of sex on outcomes following simultaneous pancreas-kidney transplantation (SPKT) in the modern era is uncertain. METHODS We retrospectively studied 255 patients undergoing SPKT from 11/2001 to 8/2020. Cases were stratified according to donor (D) sex, recipient (R) sex, 4 D/R sex categories, and D/R sex-matched versus mismatched. RESULTS D-male was associated with slightly higher patient (p = .08) and kidney (p = .002) but not pancreas (p = .23) graft survival rates (GSR) compared to D-female. There were no differences in recipient outcomes other than slightly higher pancreas thrombosis (8% R-female vs. 4.2% R-male, p = .28) and early relaparotomy rates in female recipients (38% R-female vs. 29% R-male, p = .14). When analyzing the 4 D/R sex categories, the two D-male groups had higher kidney GSRs compared to the two D-female groups (p = .01) whereas early relaparotomy and pancreas thrombosis rates were numerically higher in the D-female/R-female group compared to the other three groups. Finally, there were no significant differences in outcomes between sex-matched and sex-mismatched groups although overall survival outcomes were lower with female donors irrespective of recipient sex. CONCLUSIONS The influence of D/R sex following SPKT is subject to multiple confounding issues but survival rates appear to be higher in D-male/R-male and lower in D-female/R-male categories.
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Affiliation(s)
- David Coffman
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Colleen L Jay
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Berjesh Sharda
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Matthew Garner
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Alan C Farney
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Giuseppe Orlando
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Amber Reeves-Daniel
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Alejandra Mena-Gutierrez
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Natalia Sakhovskaya
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Robert Stratta
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| | - Robert J Stratta
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
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Durán Martínez M, Calleja Lozano R, Arjona-Sánchez Á, Sánchez-Hidalgo JM, Ayllón Terán MD, Rodríguez-Ortiz L, Campos Hernández P, Rodríguez-Benot A, Briceño Delgado J. Short- and Long-Term Intestinal Complications After Combined Pancreas-Kidney Transplantation. Transplant Proc 2022; 54:2467-2470. [PMID: 36328814 DOI: 10.1016/j.transproceed.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Simultaneous pancreas-kidney (SPK) transplantation is the treatment of choice in patients with type 1 diabetes and end-stage renal disease, because it improves survival and quality of life. Currently, enteric exocrine drainage is the most commonly used method. Intestinal complications continue to be a major cause of posttransplant morbidity despite improvements in surgical technique. This study analyzed early and late intestinal complications related to SPK transplantation. MATERIALS AND METHODS We performed a retrospective analysis of 100 adult patients undergoing SPK transplantation between January 2009 and December 2019. We performed systemic venous drainage and exocrine enteric drainage with duodenojejunostomy. Statistical analysis was performed using SPSS v2. This study was performed in accordance with the Declaration of Istanbul and the 1964 Declaration of Helsinki. Informed consent was obtained from all participants involved in the study. RESULTS Intestinal complications were reported in 18 patients. Ten patients (10%) had the following early intestinal complications including: ileus (n = 4), intestinal obstruction (n = 2), graft volvulus (n = 1), duodenal graft fistula (n = 1), and jejunal fistula after pancreas transplantation (n = 1). Two cases required relaparotomy: graft repositioning with Roux-en-Y conversion (n = 1) and Y-roux conversion (n = 1). Eight patients had repeated episodes of intestinal obstruction (8%), of whom 2 required surgery for resolution with 100% postoperative mortality. CONCLUSIONS SPK transplantation with enteric drainage via duodenojejunostomy has a low rate of short- and long-term postoperative intestinal complications. Surgery in patients with recurrent intestinal obstruction has a high mortality risk and should be performed in reference transplant centers.
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Affiliation(s)
- Manuel Durán Martínez
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - Rafael Calleja Lozano
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain.
| | - Álvaro Arjona-Sánchez
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - Juan Manuel Sánchez-Hidalgo
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - María Dolores Ayllón Terán
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | - Lidia Rodríguez-Ortiz
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery, Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
| | | | | | - Javier Briceño Delgado
- Department of General and Digestive Surgery, Reina Sofía University Hospital, Córdoba, Spain; GC18 Translational Research in Surgery of Solid Organ Transplantation, Maimonides Biomedical Research Institute of Córdoba, Córdoba, Spain
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