1
|
Masset C, Branchereau J, Buron F, Karam G, Rabeyrin M, Renaudin K, Le Borgne F, Badet L, Matillon X, Legendre C, Glotz D, Antoine C, Giral M, Dantal J, Cantarovich D. The role of donor hypertension and angiotensin II in the occurrence of early pancreas allograft thrombosis. Front Immunol 2024; 15:1359381. [PMID: 38873595 PMCID: PMC11170105 DOI: 10.3389/fimmu.2024.1359381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 04/29/2024] [Indexed: 06/15/2024] Open
Abstract
Background About 10-20% of pancreas allografts are still lost in the early postoperative period despite the identification of numerous detrimental risk factors that correlate with graft thrombosis. Methods We conducted a multicenter study including 899 pancreas transplant recipients between 2000 and 2018. Early pancreas failure due to complete thrombosis, long-term pancreas, kidney and patient survivals were analyzed and adjusted to donor, recipient and perioperative variables using a multivariate cause-specific Cox model stratified to transplant centers. Results Pancreas from donors with history of hypertension (6.7%), as well as with high body mass index (BMI), were independently associated with an increased risk of pancreas failure within the first 30 post-operative days (respectively, HR= 2.57, 95% CI from 1.35 to 4.89 and HR= 1.11, 95% CI from 1.04 to 1.19). Interaction term between hypertension and BMI was negative. Donor hypertension also impacted long-term pancreas survival (HR= 1.88, 95% CI from 1.13 to 3.12). However, when pancreas survival was calculated after the postoperative day 30, donor hypertension was no longer a significant risk factor (HR= 1.22, 95% CI from 0.47 to 3.15). A lower pancreas survival was observed in patients receiving a pancreas from a hypertensive donor without RAAS (Renin Angiotensin Aldosterone System) blockers compared to others (50% vs 14%, p < 0.001). Pancreas survival was similar among non-hypertensive donors and hypertensive ones under RAAS blockers. Conclusion Donor hypertension was a significant and independent risk factor of pancreas failure. The well-known pathogenic role of renin-angiotensin-aldosterone system seems to be involved in the genesis of this immediate graft failure.
Collapse
Affiliation(s)
- Christophe Masset
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Julien Branchereau
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Fanny Buron
- Groupement Hospitalier Edouard Herriot Service d’urologie chirurgie de la transplantation, Lyon, France
| | - Georges Karam
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Maud Rabeyrin
- Groupement Hospitalier Edouard Herriot, Service d’anatomie et pathologie, Lyon, France
| | - Karine Renaudin
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
- Service d’anatomie et pathologie, CHU de Nantes, Nantes, France
| | | | - Lionel Badet
- Groupement Hospitalier Edouard Herriot Service d’urologie chirurgie de la transplantation, Lyon, France
| | - Xavier Matillon
- Groupement Hospitalier Edouard Herriot Service d’urologie chirurgie de la transplantation, Lyon, France
| | - Christophe Legendre
- Department of Nephrology and Kidney Transplantation, Necker Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Denis Glotz
- Institut de Recherche Saint Louis, INSERM U976, Paris, France
| | - Corinne Antoine
- Institut de Recherche Saint Louis, INSERM U976, Paris, France
| | - Magali Giral
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Jacques Dantal
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| | - Diego Cantarovich
- Institut de Transplantation-Urologie-Néphrologie (ITUN), Nantes University Hospital, Nantes, France
- Nantes Université, INSERM, Center for Research in Transplantation and Translational Immunology, UMR 1064, Nantes, France
| |
Collapse
|
2
|
Zachary J, Chen JM, Sharfuddin A, Yaqub M, Lutz A, Powelson J, Fridell JA, Barros N. Epidemiology and Risk Factors for Invasive Fungal Infections in Pancreas Transplant in the Absence of Postoperative Antifungal Prophylaxis. Open Forum Infect Dis 2023; 10:ofad478. [PMID: 37942464 PMCID: PMC10629350 DOI: 10.1093/ofid/ofad478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 09/20/2023] [Indexed: 11/10/2023] Open
Abstract
Background Invasive fungal infections (IFIs) remain a rare yet dreaded complication following pancreas transplantation. Current guidelines recommend antifungal prophylaxis in patients with 1 or more risk factors. At our center, single-dose antifungal prophylaxis is administered in the operating room but none subsequently, regardless of risk factors. Here we evaluate the 1-year incidence, outcome, and risk factors associated with IFI following pancreas transplantation. Methods A retrospective, single-center cohort study was conducted in patients who underwent pancreas transplantation between 1 January 2009 and 31 December 2019. Records were manually reviewed, and cases were adjudicated using consensus definitions. The 1-year cumulative incidence, mortality, and risk factors were analyzed by Kaplan-Meier method and differences between populations were assessed with Fisher test and Mann-Whitney U test. Results Three hundred sixty-nine recipients were included. Twelve IFIs were identified: candidiasis (8), aspergillosis (2), histoplasmosis (1), and cryptococcosis (1). Intra-abdominal infections were the most common presentation (5), followed by bloodstream infections (3), disseminated disease (2), pulmonary disease (1), and invasive fungal sinusitis (1). Median time to IFI was 64 days (interquartile range, 30-234 days). One-year cumulative incidence was 3.25% (95% confidence interval, 1.86%-5.65%). There were no significant differences between patients with or without IFI regarding type of transplant (P = .17), posttransplant dialysis (P = .3), rejection (P = .5), cytomegalovirus serostatus (P = .45), or reoperation (P = .19). For patients with IFI, the 1-year graft and patient survival rates were 58% versus 95% (P < .0001) and 75% versus 98.6% (P < .001), respectively. Conclusions Our study suggests that the use of a single-dose antifungal prophylaxis administered in the operating room but none subsequently does not result in an increased incidence of IFI following pancreas transplantation.
Collapse
Affiliation(s)
- Jessica Zachary
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - Jeanne M Chen
- Department of Pharmacy, Indiana University Health, Indianapolis, Indiana, USA
| | - Asif Sharfuddin
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Muhammad Yaqub
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Andrew Lutz
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - John Powelson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Jonathan A Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nicolas Barros
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| |
Collapse
|
3
|
Offerni JCM, Ai Li E, Rasmussen A, Xie WY, Levine MA, Murkin J, McAlister VC, Luke PP, Sener A. A Prospective Study of the Effect of Gastroduodenal Artery Reconstruction on Duodenal Oxygenation and Enzyme Content After Pancreas Transplantation. World J Surg 2023; 47:2846-2856. [PMID: 37700108 PMCID: PMC10545614 DOI: 10.1007/s00268-023-07149-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Whole pancreas transplantation provides durable glycemic control and can improve survival rate; however, it can carry an increased risk of surgical complications. One devastating complication is a duodenal leak at the site of enteroenteric anastomosis. The gastroduodenal artery (GDA) supplies blood to the donor duodenum and pancreas but is commonly ligated during procurement. Since we have not had expressive changes in pancreatic back table surgical techniques in the recent decades, we hypothesized whether back table GDA reconstruction, improving perfusion of the donor duodenum and head of the pancreas, could lead to fewer surgical complications in simultaneous pancreas-kidney (SPK) transplants. MATERIAL AND METHODS Between 2017 and 2021, we evaluated demographic information, postoperative complications, intraoperative donor duodenum, recipient bowel O2 tissue saturation, and patient morbidity through the Comprehensive Complication Index (CCI®). RESULTS A total of 26 patients were included: 13 underwent GDA reconstruction (GDA-R), and 13 had GDA ligation (GDA-L). There were no pancreatic leaks in the GR group compared to 38% (5/13) in the GDA-L group (p = 0.03913). Intraoperative tissue oxygen saturation was higher in the GDA-R group than in the GDA-L (95.18 vs.76.88%, p < 0,001). We observed an increase in transfusion rate in GDA-R (p < 0.05), which did not result in a higher rate of exploration (p = 0.38). CCI® patient morbidity was also significantly lower in the GDA-R group (s < 0.05). CONCLUSIONS This study identified improved intraoperative duodenal tissue oxygen saturation in the GDA-R group with an associated reduction in pancreatic leaks and CCI® morbidity risk. A larger prospective multicenter study comparing the two methods is warranted.
Collapse
Affiliation(s)
- Juliano C M Offerni
- Department of General Surgery, Division of Urology, University of Manitoba, Winnipeg, MB, Canada
| | - Erica Ai Li
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Andrew Rasmussen
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Wen Y Xie
- Division of Transplantation and Hepatobiliary Surgery, University of Florida, Gainesville, FL, USA
| | - Max A Levine
- Division of Urology, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - John Murkin
- Department of Anesthesia & Perioperative Medicine at Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Vivian C McAlister
- University of Western Ontario, London, ON, Canada
- Department of General Surgery, London Health Sciences Center, London, ON, Canada
| | - Patrick P Luke
- University of Western Ontario, London, ON, Canada
- Division of Urology, Schulich School of Medicine & Dentistry, London Health Sciences Center, LHSC University Hospital, Western University, C4208, 339 Windermere Road, London, ON, N6A 5A5, Canada
| | - Alp Sener
- University of Western Ontario, London, ON, Canada.
- Division of Urology, Schulich School of Medicine & Dentistry, London Health Sciences Center, LHSC University Hospital, Western University, C4208, 339 Windermere Road, London, ON, N6A 5A5, Canada.
| |
Collapse
|
4
|
Budhiraja P, Reddy KS, Heilman RL, Jadlowiec CC, Khamash H, Reddy S, Katariya N, Chakkera HA. Favorable outcomes in Hispanic recipients receiving simultaneous pancreas kidney transplantation. Clin Transplant 2023; 37:e15062. [PMID: 37378620 DOI: 10.1111/ctr.15062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
The objective of this study was to compare the long-term outcomes of Hispanic versus white recipients who underwent simultaneous pancreas kidney transplantation (SPKT). This single-center study, conducted from 2003 to 2022, had a median follow-up of 7.5 years. The study included 91 Hispanic and 202 white SPKT recipients. The mean age (44 vs. 46 years), percentage of males (67% vs. 58%), and body mass index (BMI) (25.6 vs. 25.3 kg/m2 ) were similar between the Hispanic and white groups. The Hispanic group had more recipients with type 2 diabetes (38%) compared to the white group (5%, p < .001). The duration of dialysis was longer in Hispanics (640 vs. 473 days, p = .02), and fewer patients received preemptive transplants (10% vs. 29%, p < .01) compared to whites. Hospital length of stay, rates of BK Viremia, and acute rejection episodes within 1 year were similar between the groups. The estimated 5-year kidney, pancreas, and patient survival rates were also similar between the groups, 94%, 81%, and 95% in Hispanics, compared to 90%, 79%, and 90% in whites. Increasing age and longer duration of dialysis were risk factors for death. Although Hispanic recipients had a longer duration on dialysis and fewer preemptive transplants, the survival rates were similar to those of white recipients. However, referring providers and many transplant centers continue to overlook pancreas transplants for appropriately selected patients with type 2 diabetes, particularly among minority populations. As a transplant community, it is crucial that we make efforts to comprehend and tackle these obstacles to transplantation.
Collapse
Affiliation(s)
- Pooja Budhiraja
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Kunam S Reddy
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | | | - Hassan Khamash
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Swetha Reddy
- Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Nitin Katariya
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | |
Collapse
|
5
|
Mizerska A, Durlik M, Kędzierska-Kapuza K. Nutritional Risk of Candidates for Simultaneous Pancreatic-Kidney Transplantation-A Narrative Review. Nutrients 2023; 15:4179. [PMID: 37836461 PMCID: PMC10574362 DOI: 10.3390/nu15194179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/15/2023] Open
Abstract
INTRODUCTION Not much is known about the significance of nutritional status and support in transplant surgery, least of all in simultaneous pancreatic and kidney transplantation. Malnutrition in the context of simultaneous pancreatic-kidney transplantation seems to be complex and a still poorly investigated problem. Since SPKTX is highly qualified and also has a small volume procedure, it is difficult to obtain data from large cohorts of patients. The aim of this article is to gather existing evidence and information about the subject, as well as to elicit some questions and goals for the future. METHODS We searched through the Pub-Med database using the keywords "pancreas and kidney transplantation" combined with "nutritional risk", "nutritional status", "malnutrition", "nutritional intervention", and "frailty", finding a total of 4103 matching results. We then narrowed it down to articles written in English with the full text available. We also researched through the references of articles most accurately matching our researched terms. RESULTS There are numerous tools that have been investigated for the screening of malnutrition, such as the NRI index, PNI index, NLR, SGA scale, and NRS-2002 scale, each of which proved to be of some use in predicting patient outcomes in different surgical settings. Since all of them differed in components and assessed parameters and, in the absence of more sensitive or infallible indicators, the most reasonable approach seems to evaluate them jointly. CONCLUSION It is important to underline the necessity of nutritional screening and the subsequent introduction of adequate therapy while awaiting transplantation in an attempt to improve results. Considering the complexity of surgical procedures and the severity of underlying diseases with their intense metabolic components, the patient's nutritional status seems to significantly influence results. Consequently, nutritional risk assessments should be a part of the routine care of patients qualified for transplantation.
Collapse
Affiliation(s)
- Agnieszka Mizerska
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute of the Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland;
| | - Marek Durlik
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute of the Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland;
| | - Karolina Kędzierska-Kapuza
- Department of Gastroenterological Surgery and Transplantology, Centre of Postgraduate Medical Education, Marymoncka St. 99/103, 01-813 Warsaw, Poland
| |
Collapse
|
6
|
Parajuli S, Odorico J, Breyer I, Zona E, Aziz F, Lorden H, Garonzik-Wang J, Kaufman D, Mandelbrot D. Analysis of Individual Components of Frailty in Simultaneous Pancreas and Kidney, and Solitary Pancreas Transplant Recipients. Transplant Direct 2023; 9:e1523. [PMID: 37649788 PMCID: PMC10465099 DOI: 10.1097/txd.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/09/2023] [Accepted: 06/14/2023] [Indexed: 09/01/2023] Open
Abstract
Backgrounds It is not known which of the 5 components of the Fried frailty score have the most predictive value for outcomes in simultaneous pancreas-kidney transplant (SPK) and solitary pancreas transplant (SPT) recipients. Methods In this study, we sought to investigate the association between pretransplant overall frailty and individual frailty components, with posttransplant outcomes among SPK and SPT recipients. Outcomes of interest were length of stay, kidney delayed graft function (K-DGF), readmission within 30 d after discharge, cardiovascular events, acute rejection, pancreas death-censored graft failure (DCGF), kidney DCGF, and death. Results Of the individual frailty components among SPK (n = 113), only slow walk time was associated with an increased risk of mortality (adjusted odds ratio [aOR]: 4.99; P = 0.03). Among SPT (n = 49), higher sum frailty scores (coefficient correlation 0.29; P = 0.04) and weight loss (coefficient correlation = 0.30; P = 0.03) were associated with prolonged length of stay. Similarly, weight loss among SPT was associated with an increased risk of DCGF (aOR: 4.34; P = 0.049). Low grip strength was strongly associated with an increased risk of early readmission (aOR: 13.08; P = 0.008). Conclusions We found that not all components of frailty contribute equally to predicting outcomes. Objective measurements of slow walk time, unintentional weight loss, and low grip strength were found to be associated with less optimal outcomes in pancreas transplant recipients. Targeted interventions may improve posttransplant outcomes.
Collapse
Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- UW Health Transplant Center
| | - Jon Odorico
- UW Health Transplant Center
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Isabel Breyer
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Emily Zona
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- UW Health Transplant Center
| | - Heather Lorden
- UW Health Transplant Center
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jacqueline Garonzik-Wang
- UW Health Transplant Center
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dixon Kaufman
- UW Health Transplant Center
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Didier Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- UW Health Transplant Center
| |
Collapse
|
7
|
Kaku K, Okabe Y, Kubo S, Sato Y, Mei T, Noguchi H, Tomimaru Y, Ito T, Kenmochi T, Nakamura M. Utilization of the Pancreas From Donors With an Extremely High Pancreas Donor Risk Index: Report of the National Registry of Pancreas Transplantation. Transpl Int 2023; 36:11132. [PMID: 37266029 PMCID: PMC10229828 DOI: 10.3389/ti.2023.11132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 05/05/2023] [Indexed: 06/03/2023]
Abstract
Pancreas transplants from expanded criteria donors are performed widely in Japan because there is a shortage of brain-dead donors. However, the effectiveness of this strategy is unknown. We retrospectively studied 371 pancreas transplants to evaluate the possibility of pancreas transplantation from expanded criteria donors by the Pancreas Donor Risk Index (PDRI). Patients were divided into five groups according to quintiles of PDRI values (Q1-Q5). The 1-year pancreas graft survival rates were 94.5% for Q1, 91.9% for Q2, 90.5% for Q3, 89.3% for Q4, and 79.6% for Q5, and were significantly lower with a lower PDRI (p = 0.04). A multivariate analysis showed that the PDRI, donor hemoglobin A1c values, and pancreas transplantation alone significantly predicted 1-year pancreas graft survival (all p < 0.05). Spline curve analysis showed that the PDRI was incrementally associated with an increased risk of 1-year graft failure. In the group with a PDRI ≥ 2.87, 8/56 patients had graft failures within 1 month, and all were due to graft thrombosis. The PDRI is a prognostic factor related to the 1-year graft survival rate. However, pancreas transplantation from high-PDRI donors shows acceptable results and could be an alternative when the donor pool is insufficient.
Collapse
Affiliation(s)
- Keizo Kaku
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasuhiro Okabe
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinsuke Kubo
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yu Sato
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanori Mei
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroshi Noguchi
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshito Tomimaru
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
- The Japan Pancreas Transplant Registry, Japan Society for Pancreas and Islet Transplantation, Suita, Japan
| | - Toshinori Ito
- The Japan Pancreas Transplant Registry, Japan Society for Pancreas and Islet Transplantation, Suita, Japan
- Osaka Center for Cancer and Cardiovascular Disease Prevention, Osaka, Japan
| | - Takashi Kenmochi
- The Japan Pancreas Transplant Registry, Japan Society for Pancreas and Islet Transplantation, Suita, Japan
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| |
Collapse
|
8
|
Ai Li E, Farrokhi K, Zhang MY, Offerni J, Luke PP, Sener A. Heparin Thromboprophylaxis in Simultaneous Pancreas-Kidney Transplantation: A Systematic Review and Meta-Analysis of Observational Studies. Transpl Int 2023; 36:10442. [PMID: 36819126 PMCID: PMC9928749 DOI: 10.3389/ti.2023.10442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 01/18/2023] [Indexed: 02/04/2023]
Abstract
Thrombosis is a leading causes of pancreas graft loss after simultaneous pancreas kidney (SPK), pancreas after kidney (PAK), and pancreas transplant alone (PTA). There remains no standardized thromboprophylaxis protocol. The aim of this systematic review and meta-analysis is to evaluate the impact of heparin thromboprophylaxis on the incidence of pancreas thrombosis, pancreas graft loss, bleeding, and secondary outcomes in SPK, PAK, and PTA. Following PRISMA guidelines, we systematically searched BIOSIS®, PubMed®, Cochrane Library®, EMBASE®, MEDLINE®, and Web of Science® on April 21, 2021. Primary peer-reviewed studies that met inclusion criteria were included. Two methods of quantitative synthesis were performed to account for comparative and non-comparative studies. We included 11 studies, comprising of 1,122 patients in the heparin group and 236 patients in the no-heparin group. When compared to the no-heparin control, prophylactic heparinization significantly decreased the risk of early pancreas thrombosis and pancreas loss for SPK, PAK and PTA without increasing the incidence of bleeding or acute return to the operating room. Heparin thromboprophylaxis yields an approximate two-fold reduction in both pancreas thrombosis and pancreas loss for SPK, PAK and PTA. We report the dosage, frequency, and duration of heparin administration to consolidate the available evidence.
Collapse
Affiliation(s)
- Erica Ai Li
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Kaveh Farrokhi
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Max Y Zhang
- Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Matthew Mailing Center for Translational Transplant Studies, London, ON, Canada
| | - Juliano Offerni
- Multi-Organ Transplant Program, London Health Sciences Center, London, ON, Canada.,Department of Surgery, Division of Urology, London Health Sciences Center, London, ON, Canada
| | - Patrick P Luke
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Matthew Mailing Center for Translational Transplant Studies, London, ON, Canada.,Multi-Organ Transplant Program, London Health Sciences Center, London, ON, Canada.,Department of Surgery, Division of Urology, London Health Sciences Center, London, ON, Canada
| | - Alp Sener
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Department of Microbiology and Immunology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.,Matthew Mailing Center for Translational Transplant Studies, London, ON, Canada.,Multi-Organ Transplant Program, London Health Sciences Center, London, ON, Canada.,Department of Surgery, Division of Urology, London Health Sciences Center, London, ON, Canada
| |
Collapse
|
9
|
Favorable Outcomes in Older Recipients Receiving Simultaneous Pancreas Kidney Transplantation. Transplant Direct 2022; 8:e1413. [PMCID: PMC9671747 DOI: 10.1097/txd.0000000000001413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
|
10
|
Parajuli S, Leverson GE, Kaufman DB, Djamali A, Welch BM, Sollinger HW, Mandelbrot DA, Odorico JS. Early Increases in Posttransplant Pancreatic Enzymes Are Associated With Surgical Complications But Not Graft Failure Among Pancreas Transplant Recipients. Pancreas 2022; 51:1381-1387. [PMID: 37099783 DOI: 10.1097/mpa.0000000000002187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
OBJECTIVES This study aimed to find the association between immediate postoperative increases in pancreatic enzymes and posttransplant complications among pancreas transplant recipients (PTRs). METHODS We analyzed all PTRs transplanted at the University of Wisconsin between June 2009 and September 2018. Enzyme levels were presented as a ratio of absolute numbers to the upper limit of normal value, with value >1 considered as abnormal. We specifically evaluated bleeding, fluid collections, and thrombosis complications based on the amylase or lipase ratios on day 1 (Amylase1, Lipase1) and maximum ratios within 5 days of transplant (Amylasemax, Lipasemax). For early complications, we focused on technical complications that occurred within 90 days of transplant. For long-term outcomes, we assessed patient and graft survival, and rejections. RESULTS There were a total of 443 PTRs, 287 were simultaneous pancreas and kidney recipients, and 156 were solitary pancreas recipients. Higher Amylase1, Liplase1, Amylasemax, and Lipasemax were associated with an increase in early complications, mainly need for pancreatectomy, fluid collections, bleeding complications, or graft thrombosis, particularly in the solitary pancreas group. CONCLUSIONS Our finding suggests that cases of early perioperative enzyme increase merit consideration for early imaging investigation to mitigate detrimental outcomes.
Collapse
Affiliation(s)
| | - Glen E Leverson
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dixon B Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Arjang Djamali
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bridget M Welch
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Hans W Sollinger
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Jon S Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| |
Collapse
|
11
|
Sharda B, Jay CL, Gurung K, Harriman D, Gurram V, Farney AC, Orlando G, Rogers J, Garner M, Stratta RJ. Improved surgical outcomes following simultaneous pancreas-kidney transplantation in the contemporary era. Clin Transplant 2022; 36:e14792. [PMID: 36029250 PMCID: PMC10078434 DOI: 10.1111/ctr.14792] [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: 06/03/2022] [Revised: 07/20/2022] [Accepted: 08/09/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Complications leading to early technical failure have been the Achilles' heel of simultaneous pancreas-kidney transplantation (SPKT). The study purpose was to analyze longitudinally our experience with early surgical complications following SPKT with an emphasis on changes in practice that improved outcomes in the most recent era. STUDY DESIGN Single center retrospective review of all SPKTs from 11/1/01 to 8/12/20 with enteric drainage. Early relaparotomy was defined as occurring within 3 months of SPKT. Patients were stratified into two sequential eras: Era 1 (E1): 11/1/01-5/30/13; Era 2 (E2) 6/1/13-8/12/20 based on changes in practice that occurred pursuant to donor age and pancreas cold ischemia time (CIT). RESULTS 255 consecutive SPKTs were analyzed (E1, n = 165; E2, n = 90). E1 patients received organs from older donors (mean E1 27.3 vs. E2 23.1 years) with longer pancreas cold CITs) (mean E1 16.1 vs. E2 13.3 h, both p < .05). E1 patients had a higher early relaparotomy rate (E1 43.0% vs. E2 14.4%) and were more likely to require allograft pancreatectomy (E1 9.1% vs. E2 2.2%, both p < .05). E2 patients underwent systemic venous drainage more frequently (E1 8% vs. E2 29%) but pancreas venous drainage did not influence either relaparotomy or allograft pancreatectomy rates. The most common indications for early relaparotomy in E1 were allograft thrombosis (11.5%) and peri-pancreatic phlegmon/abscess (8.5%) whereas in E2 were thrombosis, pancreatitis/infection, and bowel obstruction (each 3%). CONCLUSION Maximizing donor quality (younger donors) and minimizing pancreas CIT are paramount for reducing early surgical complications following SPKT.
Collapse
Affiliation(s)
- Berjesh Sharda
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Colleen L Jay
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Komal Gurung
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - David Harriman
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Venkat Gurram
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Alan C Farney
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Giuseppe Orlando
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Jeffrey Rogers
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Matthew Garner
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Robert J Stratta
- Department of Surgery, Section of Transplantation, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| |
Collapse
|
12
|
Campsen J, Zimmerman MA. Pancreas transplantation following donation after circulatory death. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
13
|
Doherty D, Khambalia H, Summers A, Moinuddin Z, Yiannoullou P, Krishnan A, Augustine T, Naish J, van Dellen D. Future imaging modalities for the assessment of pancreas allografts a scan of the horizon. Transplant Rev (Orlando) 2022; 36:100692. [DOI: 10.1016/j.trre.2022.100692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 03/22/2022] [Accepted: 03/23/2022] [Indexed: 10/18/2022]
|
14
|
Argente-Pla M, Martínez-Millana A, Espí-Reig J, Maupoey-Ibáñez J, Moya-Herráiz Á, Beneyto-Castello I, López-Andújar R, Merino-Torres JF. Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana. Cir Esp 2021; 99:666-677. [PMID: 34674986 DOI: 10.1016/j.cireng.2021.10.001] [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: 04/23/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4 ± 5.7 years, mean BMI 24.1 ± 3.4 kg/m2, mean duration of diabetes 25.5 ± 6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91.3%, 91.3% and 89.5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2% and 93.6% at one year, 88.2% and 93.7% at 3 years, and 85.3% and 93.7% at 5 years, respectively (P = 1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2%, 69.1% and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5% and 80.6% at one year, 64.7% and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P = .0109). Post-transplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS In 13 years' experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.
Collapse
Affiliation(s)
- María Argente-Pla
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, Spain.
| | | | - Jordi Espí-Reig
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Javier Maupoey-Ibáñez
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Ángel Moya-Herráiz
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | | | - Rafael López-Andújar
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Juan Francisco Merino-Torres
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, Spain; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, Spain; Departament de Medicina, Universitat de València, Valencia, Spain
| |
Collapse
|
15
|
Wang H, Fu YX, Song WL, Mo CB, Feng G, Zhao J, Pei GH, Shi XF, Wang Z, Cao Y, Nian YQ, Shen ZY. Suture ligation for submucosal hemostasis during hand-sewn side-to-side duodeno-ileostomy in simultaneous pancreas and kidney transplantation. World J Gastrointest Surg 2021; 13:988-999. [PMID: 34621475 PMCID: PMC8462074 DOI: 10.4240/wjgs.v13.i9.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/17/2021] [Accepted: 08/10/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Enteric anastomotic (EA) bleeding is a potentially life-threatening surgical complication associated with enteric anastomosis during simultaneous pancreas and kidney transplantation (SPKT).
AIM To investigate whether suture ligation (SL) for submucosal hemostasis during hand-sewn enteric anastomosis could decrease the morbidity of early EA bleeding in SPKT.
METHODS We compared the outcomes of 134 patients classified into SL (n = 44) and no SL (NSL) groups (n = 90). This study adheres to the declarations of Istanbul and Helsinki and all donors were neither paid nor coerced.
RESULTS During the first postoperative week, the EA bleeding rate in the SL group was lower than that in the NSL group (2.27% vs 15.56%; P = 0.021); no relationship was found between EA bleeding and donor age, mean pancreatic cold ischemia time, platelet count, prothrombin time international normalized rate, activated partial thromboplastin time, and thrombin time. Anastomotic leakage was observed in one case in the SL group at postoperative day (POD) 14 and in one case at POD 16 in the NSL group (P = 0.754). No significant difference was found between the two groups in the patient survival, pancreas graft survival, or kidney graft survival.
CONCLUSION SL for submucosal hemostasis during hand-sewn enteric anastomosis in SPKT can decrease the morbidity of early EA bleeding without increasing the anastomotic leakage rate.
Collapse
Affiliation(s)
- Hui Wang
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Ying-Xin Fu
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Wen-Li Song
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Chun-Bai Mo
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Gang Feng
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Jie Zhao
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Guang-Hui Pei
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Xiao-Feng Shi
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Zhen Wang
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Yu Cao
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Ye-Qi Nian
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| | - Zhong-Yang Shen
- Department of Kidney and Pancreas Transplant, Tianjin First Central Hospital, School of Medicine, Nankai University, Tianjin 300192, China
| |
Collapse
|
16
|
Boggi U, Vistoli F, Andres A, Arbogast HP, Badet L, Baronti W, Bartlett ST, Benedetti E, Branchereau J, Burke GW, Buron F, Caldara R, Cardillo M, Casanova D, Cipriani F, Cooper M, Cupisti A, Davide J, Drachenberg C, de Koning EJP, Ettorre GM, Fernandez Cruz L, Fridell JA, Friend PJ, Furian L, Gaber OA, Gruessner AC, Gruessner RW, Gunton JE, Han D, Iacopi S, Kauffmann EF, Kaufman D, Kenmochi T, Khambalia HA, Lai Q, Langer RM, Maffi P, Marselli L, Menichetti F, Miccoli M, Mittal S, Morelon E, Napoli N, Neri F, Oberholzer J, Odorico JS, Öllinger R, Oniscu G, Orlando G, Ortenzi M, Perosa M, Perrone VG, Pleass H, Redfield RR, Ricci C, Rigotti P, Paul Robertson R, Ross LF, Rossi M, Saudek F, Scalea JR, Schenker P, Secchi A, Socci C, Sousa Silva D, Squifflet JP, Stock PG, Stratta RJ, Terrenzio C, Uva P, Watson CJ, White SA, Marchetti P, Kandaswamy R, Berney T. First World Consensus Conference on pancreas transplantation: Part II - recommendations. Am J Transplant 2021; 21 Suppl 3:17-59. [PMID: 34245223 PMCID: PMC8518376 DOI: 10.1111/ajt.16750] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 02/07/2023]
Abstract
The First World Consensus Conference on Pancreas Transplantation provided 49 jury deliberations regarding the impact of pancreas transplantation on the treatment of diabetic patients, and 110 experts' recommendations for the practice of pancreas transplantation. The main message from this consensus conference is that both simultaneous pancreas-kidney transplantation (SPK) and pancreas transplantation alone can improve long-term patient survival, and all types of pancreas transplantation dramatically improve the quality of life of recipients. Pancreas transplantation may also improve the course of chronic complications of diabetes, depending on their severity. Therefore, the advantages of pancreas transplantation appear to clearly surpass potential disadvantages. Pancreas after kidney transplantation increases the risk of mortality only in the early period after transplantation, but is associated with improved life expectancy thereafter. Additionally, preemptive SPK, when compared to SPK performed in patients undergoing dialysis, appears to be associated with improved outcomes. Time on dialysis has negative prognostic implications in SPK recipients. Increased long-term survival, improvement in the course of diabetic complications, and amelioration of quality of life justify preferential allocation of kidney grafts to SPK recipients. Audience discussions and live voting are available online at the following URL address: http://mediaeventi.unipi.it/category/1st-world-consensus-conference-of-pancreas-transplantation/246.
Collapse
|
17
|
Too Fat for Transplant? The Impact of Recipient BMI on Pancreas Transplant Outcomes. Transplantation 2021; 105:905-915. [PMID: 33741849 DOI: 10.1097/tp.0000000000003334] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND In many transplant centers, a recipient body mass index (BMI) >30 kg/m2 would be considered a contraindication for pancreas transplantation. This study aims to investigate the impact of recipient BMI on graft outcomes after pancreas transplantation. METHODS Retrospective data on all UK solid organ pancreas transplants from 1994 to 2016 were obtained from the National Health Service Blood and Transplant UK Transplant Registry, n = 2618. Cases missing BMI data were excluded, resulting in a final cohort of n = 1452. Graft and patient survival analysis were conducted using Kaplan-Meier plots and Cox regression models. RESULTS The mean recipient BMI was 24.8 kg/m2 (±2.4). There were 507 overweight (BMI 25-29.9) and 146 obese (>30) recipients receiving pancreas transplants. Univariate analysis showed no statistically significant difference between overweight BMI categories compared with normal BMI (18.5-24.9 kg/m2). Multivariate analysis revealed increasing recipient BMI had a significant impact on graft survival (P = 0.03, hazard ratio 1.04, 95% confidence interval, 1.00-1.08). Receiver operating characteristic curve analyses revealed no value of BMI that provided both specific and sensitive discrimination between death and survival of both grafts or patients. Recipients on dialysis with a BMI >30 kg/m2 had a statistically significant decrease in both graft (P = 0.002) and patient survival (P = 0.015). CONCLUSIONS Analysis of available UK Pancreas data has shown recipient BMI is an independent risk factor for patient survival after transplantation. However, we have been unable to define a specific cutoff value above which patients have poorer outcomes. Obese patients on hemodialysis had the poorest graft survival, and preemptive transplantation may be beneficial in this cohort.
Collapse
|
18
|
Lehner LJ, Öllinger R, Globke B, Naik MG, Budde K, Pratschke J, Eckardt KU, Kahl A, Zhang K, Halleck F. Impact of Early Pancreatic Graft Loss on Outcome after Simultaneous Pancreas-Kidney Transplantation (SPKT)-A Landmark Analysis. J Clin Med 2021; 10:jcm10153237. [PMID: 34362019 PMCID: PMC8347953 DOI: 10.3390/jcm10153237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/16/2021] [Accepted: 07/21/2021] [Indexed: 01/06/2023] Open
Abstract
(1) Background: Simultaneous pancreas-kidney transplantation (SPKT) is a standard therapeutic option for patients with diabetes mellitus type I and kidney failure. Early pancreas allograft failure is a complication potentially associated with worse outcomes. (2) Methods: We performed a landmark analysis to assess the impact of early pancreas graft loss within 3 months on mortality and kidney graft survival over 10 years. This retrospective single-center study included 114 adult patients who underwent an SPKT between 2005 and 2018. (3) Results: Pancreas graft survival rate was 85.1% at 3 months. The main causes of early pancreas graft loss were thrombosis (6.1%), necrosis (2.6%), and pancreatitis (2.6%). Early pancreas graft loss was not associated with reduced patient survival (p = 0.168) or major adverse cerebral or cardiovascular events over 10 years (p = 0.741) compared to patients with functioning pancreas, after 3 months. Moreover, kidney graft function (p = 0.494) and survival (p = 0.461) were not significantly influenced by early pancreas graft loss. (4) Conclusion: In this study, using the landmark analysis technique, early pancreas graft loss within 3 months did not significantly impact patient or kidney graft survival over 10 years.
Collapse
Affiliation(s)
- Lukas Johannes Lehner
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.N.); (K.B.); (K.-U.E.); (A.K.); (F.H.)
- Correspondence: ; Tel.: +49-30-45-051-4002
| | - Robert Öllinger
- Department of Surgery, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (R.Ö.); (B.G.); (J.P.)
| | - Brigitta Globke
- Department of Surgery, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (R.Ö.); (B.G.); (J.P.)
| | - Marcel G. Naik
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.N.); (K.B.); (K.-U.E.); (A.K.); (F.H.)
- Berlin Institute of Health (BIH), 10117 Berlin, Germany;
| | - Klemens Budde
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.N.); (K.B.); (K.-U.E.); (A.K.); (F.H.)
| | - Johann Pratschke
- Department of Surgery, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany; (R.Ö.); (B.G.); (J.P.)
| | - Kai-Uwe Eckardt
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.N.); (K.B.); (K.-U.E.); (A.K.); (F.H.)
| | - Andreas Kahl
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.N.); (K.B.); (K.-U.E.); (A.K.); (F.H.)
| | - Kun Zhang
- Berlin Institute of Health (BIH), 10117 Berlin, Germany;
- Department of Internal Medicine and Cardiology, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology and Medical Intensive Care, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.N.); (K.B.); (K.-U.E.); (A.K.); (F.H.)
| |
Collapse
|
19
|
Blundell J, Shahrestani S, Lendzion R, Pleass HJ, Hawthorne WJ. Risk Factors for Early Pancreatic Allograft Thrombosis Following Simultaneous Pancreas-Kidney Transplantation: A Systematic Review. Clin Appl Thromb Hemost 2021; 26:1076029620942589. [PMID: 33052066 PMCID: PMC7573738 DOI: 10.1177/1076029620942589] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Simultaneous pancreas-kidney (SPK) transplantation remains the most effective treatment for providing consistent and long-term euglycemia in patients having type 1 diabetes with renal failure. Thrombosis of the pancreatic vasculature continues to contribute significantly to early graft failure and loss. We compared the rate of thrombosis to graft loss and systematically reviewed risk factors impacting early thrombosis of the pancreas allograft following SPK transplantation. We searched the MEDLINE, EMBASE, The Cochrane Library, and PREMEDLINE databases for studies reporting thrombosis following pancreas transplantation. Identified publications were screened for inclusion and synthesized into a data extraction sheet. Sixty-three studies satisfied eligibility criteria: 39 cohort studies, 22 conference abstracts, and 2 meta-analyses. Newcastle-Ottawa Scale appraisal of included studies demonstrated cohort studies of low bias risk; 1127 thrombi were identified in 15 936 deceased donor, whole pancreas transplants, conferring a 7.07% overall thrombosis rate. Thrombosis resulted in pancreatic allograft loss in 83.3% of reported cases. This review has established significant associations between donor and recipient characteristics, procurement and preservation methodology, transplantation technique, postoperative management, and increased risk of early thrombosis in the pancreas allograft. Further studies examining the type of organ preservation fluid, prophylactic heparin protocol, and exocrine drainage method and early thrombosis should also be performed.
Collapse
Affiliation(s)
- Jian Blundell
- Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Sara Shahrestani
- Sydney Medical School, University of Sydney, New South Wales, Australia.,Department of Surgery, University of Sydney at Westmead Hospital, New South Wales, Australia
| | - Rebecca Lendzion
- Department of Surgery, University of Sydney at Westmead Hospital, New South Wales, Australia
| | - Henry J Pleass
- Sydney Medical School, University of Sydney, New South Wales, Australia.,Department of Surgery, University of Sydney at Westmead Hospital, New South Wales, Australia
| | - Wayne J Hawthorne
- Sydney Medical School, University of Sydney, New South Wales, Australia.,Department of Surgery, University of Sydney at Westmead Hospital, New South Wales, Australia.,The Centre for Transplant & Renal Research, Westmead Institute for Medical Research, New South Wales, Australia
| |
Collapse
|
20
|
Peripancreatic Fluid Collections After Pancreas Transplant: Safety and Efficacy of Percutaneous Drainage. AJR Am J Roentgenol 2021; 217:404-410. [PMID: 34036810 DOI: 10.2214/ajr.20.23059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the safety and efficacy of percutaneous drainage of peripancreatic fluid collections after pancreas transplant and to determine factors predicting a successful clinical outcome. MATERIALS AND METHODS. This single-center retrospective study included 28 patients who underwent percutaneous drainage for peripancreatic collections after transplant between January 2008 and December 2018. Clinical success was defined as drainage resulting in resolution of symptoms. Primary clinical success was defined as symptom resolution after the initial drainage procedure, and secondary success was defined as symptom resolution after additional drainage procedures. Operative intervention or death was considered clinical failure. Patient, collection, and procedural factors were assessed for their potential impact on the clinical outcome. RESULTS. Clinical success was achieved in 23 of 28 drainage procedures (82.1%), with primary success in 15 procedures. Of the five patients with failed drainage procedures, three required pancreatectomies, one required surgical washout, and one died from a disseminated infection. The median duration of drainage in the clinical success group was 25 days (range, 3-136 days), and patients with longer drainage periods had more successful outcomes (p = .04). Graft pancreatitis was diagnosed in five patients (17.9%) and was not associated with drainage outcome (p = .21). Collections were positive for bacterial growth in 13 patients (46.4%) and were high in amylase in 12 (42.9%). We observed drainage failure in collections with polymicrobial growth and in the presence of fistulas (p = .05 and p = .07, respectively). Patients with successful outcomes had smaller collection volumes (p = .045). No complications attributed to drainage were encountered. CONCLUSION. Percutaneous drainage is safe and effective for management of peripancreatic fluid collections after pancreas transplant.
Collapse
|
21
|
Impact of Recipient Age on Outcomes After Pancreas Transplantation. Transplant Proc 2021; 53:2046-2051. [PMID: 34020798 DOI: 10.1016/j.transproceed.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Few reports have provided the ages of pancreas transplant recipients. The aim of this study was to determine whether recipient age affects survival of pancreatic grafts after transplantation. METHODS We analyzed 73 patients who had undergone pancreas transplantation at our institution from August 2001 to March 2020 and assessed the effects of recipient age on pancreas graft survival within 5 years after pancreas transplantation. RESULTS The cutoff value for recipient age established by receiver operating characteristic curve was 35 years. The pancreas graft survival rate of recipients aged 35 years or younger (1, 3, and 5 years: 72.9%, 41.7%, and 41.7%, respectively) was significantly lower than that of recipients aged over 35 years (1, 3, and 5 years: 93.2%, 88.4%, and 88.4%, respectively). Multivariate Cox hazard regression analysis showed that recipient age 35 years or younger (hazard ratio = 3.60; 95% confidence interval, 1.04-12.50; P = .044) and solitary pancreas transplantation (hazard ratio = 10.72; 95% confidence interval, 2.72-42.28; P < .001) were significant risk factors for pancreas graft loss within 5 years. CONCLUSION Our data suggest that younger recipient age is a risk factor for pancreas graft loss after transplantation.
Collapse
|
22
|
Shahrestani S, Hitos K, Hort A, Spike E, Gibbons TJ, Lendzion R, Yuen L, Pleass HC, Hawthorne WJ. Successful Expectant Management of Nonocclusive Thrombosis in Simultaneous Pancreas-Kidney Transplantation. Transplant Proc 2021; 53:371-378. [PMID: 33419574 DOI: 10.1016/j.transproceed.2020.10.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Simultaneous pancreas-kidney (SPK) transplantation can be complicated by thrombosis in the early post-transplant period. METHODS We performed a single-center retrospective study examining risk factors, management, and outcomes of modern era SPK transplants. We reviewed 235 recipients over 10 years (January 1, 2008, to September 1, 2017). We used multivariate analysis to examine donor, recipient, and operative risk factors for thrombosis. RESULTS Forty-one patients (17%) had a thrombosis diagnosed on postoperative imaging, but 61% of these patients (n = 25/41) did not lose their graft secondary to the thrombosis. Nine patients (22%) were managed with watchful waiting and serial imaging, 12 (29%) were managed with therapeutic anticoagulation, and 4 (10%) required laparotomy and graft thrombectomy. Sixteen of 235 pancreas grafts (6.8%) required pancreatectomy, and 10 of these cases occurred in the first half of the study, before 2012. The risk of thrombosis leading to graft loss increased 11.2-fold in recipients with a body mass index (calculated as weight in kilograms divided by height in meters squared) > 25 compared with others (odds ratio, 11.2; 95% CI, 1.1-116.7; P = .043). CONCLUSIONS The majority of SPK transplants (61%) complicated by thrombosis of the pancreatic graft were salvaged by use of imaging, anticoagulation, and in select cases, laparotomy and graft thrombectomy.
Collapse
Affiliation(s)
| | - Kerry Hitos
- Sydney Medical School, University of Sydney, Sydney, Australia; Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Amy Hort
- Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Erin Spike
- Department of Surgery, Westmead Hospital, Westmead, Australia
| | | | | | - Lawrence Yuen
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Henry C Pleass
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Surgery, Westmead Hospital, Westmead, Australia
| | - Wayne J Hawthorne
- Sydney Medical School, University of Sydney, Sydney, Australia; Department of Surgery, Westmead Hospital, Westmead, Australia; Centre for Transplant & Renal Research, Westmead Institute for Medical Research, Westmead, Australia.
| |
Collapse
|
23
|
Muñoz-Bellvís L, López-Sánchez J. Donor risk factors in pancreas transplantation. World J Transplant 2020; 10:372-380. [PMID: 33437670 PMCID: PMC7769731 DOI: 10.5500/wjt.v10.i12.372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 08/29/2020] [Accepted: 10/09/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of the work was to analyze and expose the donor and recipient risk factors in pancreas transplantation. In the following paper, we exposed the 2018 Spanish Consensus Document on Donor and Recipient Selection Criteria for Pancreas Transplantation. An assessment of the previous Selection Criteria for Donors and Recipients of Pancreas Transplantation, published in 2005 by the Spanish Pancreas Transplant Group (GETP) and the National Transplant Organization (ONT) was performed. A literature review was performed using Cochrane Library, PubMed and Google Scholar databases. Some of the following terms were used for the literature search: “Diabetes Mellitus,” “Pancreas Transplantation,” “Insulin-Secreting Cells,” “Pancreas Allograft Thrombosis,” “Allograft Pancreatitis,” “Donors’ Risk Factors,” “Recipients’ Risk Factors,” “Pancreas Allograft Rejection” and “Pancreas Allograft Survival.” After an extended search, different inclusion criteria were established. Articles and documents with abstracts of full text and in English or Spanish language were selected. Subsequently, different scientific meetings took place during 2015 and 2016 by the GETP. Finally, the updated criteria were published by the GETP and ONT in 2018. Several risk factors have been described in pancreas transplantation that can be divided into donor risk factors: Advanced age (> 50 years); high body mass index (BMI) (> 30 kg/m2); cause of death (e.g., stroke); previous hyperglycemia; hyperamylasemia; cold ischemia time (greater than 8 or 12 h, depending on the type of donation); the use of vasopressors in the intensive care unit or cardiac arrest; and the macroscopic aspect of the pancreas allograft. The following are recipient risk factors: Advanced age (> 50 years); active smoking; high BMI (> 30 kg/m2); and peripheral artery disease or sensorimotor polyneuropathy. Based on the aforementioned parameters, different selection criteria have been established for the recipients depending on the type of pancreas transplantation. Knowledge of the risk factors for pancreas transplantation allows the establishment of reliable selection criteria for choosing donors and recipients.
Collapse
Affiliation(s)
- Luis Muñoz-Bellvís
- Department of General & Gastrointestinal Surgery, Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca 37007, Spain
- Salamanca Biomedical Research Institute (IBSAL), Universidad de Salamanca, Salamanca 37007, Spain
| | - Jaime López-Sánchez
- Department of General & Gastrointestinal Surgery, Hospital Universitario de Salamanca, Universidad de Salamanca, Salamanca 37007, Spain
- Salamanca Biomedical Research Institute (IBSAL), Universidad de Salamanca, Salamanca 37007, Spain
| |
Collapse
|
24
|
Argente-Pla M, Martínez-Millana A, Espí-Reig J, Maupoey-Ibáñez J, Moya-Herráiz Á, Beneyto-Castello I, López-Andújar R, Merino-Torres JF. Results after 13 years of kidney-pancreas transplantation in type 1 diabetic patients in Comunidad Valenciana. Cir Esp 2020; 99:S0009-739X(20)30312-2. [PMID: 33341241 DOI: 10.1016/j.ciresp.2020.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Simultaneous pancreas-kidney (SPK) transplant is a proven option of treatment for patients with type 1 diabetes mellitus and related end-stage renal disease, who are candidates for kidney transplantation. The results from the beginning of SPK transplant program in Comunidad Valenciana are presented. METHODS Descriptive, retrospective, and single-center study of the pancreas transplant performed at the Hospital Universitari i Politècnic La Fe, from September 2002 to December 2015. Clinical variables from donors and recipients, peri-operative variables, patient survival, and pancreatic graft survival were collected. RESULTS Eighty-one patients with type 1 diabetes mellitus (48 males and 33 females, mean age 37.4±5.7 years, mean BMI 24.1±3.4kg/m2, mean duration of diabetes 25.5±6.5 years) received SPK transplantation. The overall patient survival at one, 3, and 5 years were 91,3, 91,3 and 89,5%, respectively. However, patient survival in the periods 2002-2008 and 2009-2015 were 88.2 and 93.6% at one year, 88.2 and 93.7% at 3 years, and 85.3 and 93.7% at 5 years, respectively (P=1). The overall pancreatic graft survival at one, 3, and 5 years were 75.2, 69.1 and 63.2%, respectively. On the other hand, pancreatic graft survival in the periods 2002-2008 and 2009-2015 were 67.5 and 80.6% at one year, 64.7 and 71.8% at 3 years, and 58.8% and 65.3% at 5 years, respectively (P=.0109). Postransplant complications were: graft rejection 8.6%, venous graft thrombosis 7.4%, graft pancreatitis 4.9%. CONCLUSIONS In 13-year's experience of SPK transplantation, patient and pancreatic graft survival and the rate of complications after pancreas transplantation were similar to those of other larger series. The medical-surgical team experience improves pancreatic graft survival without influencing patient survival.
Collapse
Affiliation(s)
- María Argente-Pla
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, España; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, España.
| | | | - Jordi Espí-Reig
- Servicio de Nefrología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Javier Maupoey-Ibáñez
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Ángel Moya-Herráiz
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | | | - Rafael López-Andújar
- Unidad de Cirugía Hepato-Bilio-Pancreática y Unidad de Trasplante, Hospital Universitario y Politécnico La Fe, Valencia, España; CIBERehd, Instituto de Salud Carlos III, Madrid, España
| | - Juan Francisco Merino-Torres
- Servicio de Endocrinología y Nutrición, Hospital Universitario y Politécnico La Fe, Valencia, España; Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética, Instituto de Investigación La Fe, Valencia, España; Departament de Medicina, Universitat de València, Valencia, España
| |
Collapse
|
25
|
Das DM, Huskey JL, Harbell JW, Heilman RL, Singer AL, Mathur A, Neville MR, Morgan P, Reddy KS, Jadlowiec CC. Early technical pancreas failure in Simultaneous Pancreas-Kidney Recipients does not impact renal allograft outcomes. Clin Transplant 2020; 35:e14138. [PMID: 33131111 DOI: 10.1111/ctr.14138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/12/2020] [Accepted: 10/19/2020] [Indexed: 01/08/2023]
Abstract
Early pancreas loss in simultaneous pancreas-kidney (SPK) transplants has been associated with longer perioperative recovery and reduced kidney allograft function. We assessed the impact of early pancreas allograft failure on transplant outcomes in a contemporary cohort of SPK patients (n = 218). Early pancreas allograft loss occurred in 12.8% (n = 28) of recipients. Delayed graft function (DGF) was more common (21.4% vs. 7.4%, p = 0.03) in the early pancreas loss group, but there were no differences in hospital length of stay (median 6.5 vs. 7.0, p = 0.22), surgical wound complications (p = 0.12), or rejection episodes occurring in the first year (p = 0.87). Despite differences in DGF, both groups had excellent renal function at 1 year post-transplant (eGFR 64.1 ± 20.8 vs. 65.8 ± 22.9, p = 0.75). There were no differences in patient (HR 0.58, 95% CI 0.18-1.87, p = 0.26) or kidney allograft survival (HR 0.84, 95% CI 0.23-3.06, p = 0.77). One- and 2-year protocol kidney biopsies were comparable between the groups and showed minimal chronic changes; the early pancreas loss group showed more cv changes at 2 years (p = 0.04). Current data demonstrate good outcomes and excellent kidney allograft function following early pancreas loss.
Collapse
Affiliation(s)
- Devika M Das
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | | | - Jack W Harbell
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | | - Andrew L Singer
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Amit Mathur
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Matthew R Neville
- Instructor in Biostatistics, Mayo Clinic College of Medicine, Phoenix, AZ, USA
| | - Paige Morgan
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Kunam S Reddy
- Division of Transplant Surgery, Mayo Clinic, Phoenix, AZ, USA
| | | |
Collapse
|
26
|
Flateau C, Aït-Ammar N, Angebault C, Salomon L, Matignon M, Lepeule R, Melica G, Grimbert P, Lelièvre JD, Gallien S, Botterel F. Risk factors for intra-abdominal fungal infection after simultaneous pancreas-kidney transplantation: A single-center retrospective experience. Transpl Infect Dis 2020; 23:e13486. [PMID: 33047447 DOI: 10.1111/tid.13486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/17/2020] [Accepted: 09/20/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Data on the risk factors and outcome of intra-abdominal fungal infections (IAFI) following simultaneous pancreas-kidney transplantation (PKT) are scarce. MATERIALS/METHODS A retrospective monocentric study was conducted on all patients who underwent simultaneous PKT from January 2007 to December 2016. Deep sites positive cultures for fungi during the first post-transplantation year were collected. Clinical, radiological, and microbiological data of proven and probable invasive fungal infections were analysed. RESULTS Among sixteen PKT patients, 15 were included. Seven patients (47%) developed an invasive fungal infection, exclusively IAFI (six proven, one probable). The proven IAFI included four peritonitis, one pancreatic necrosis with infected hematoma, and one patient with positive preservation fluid only (PF). Candida albicans (n = 4) was the most prevalent species (associated with Galactomyces candidus in one case), C glabrata, C dubliniensis, and C krusei were found in one case each. Three patients had either a positive direct examination and/or culture for renal or pancreatic PF and the culture of PF was positive for the same species that caused IAFI. IAFIs were significantly associated with pancreatic graft arterial thrombosis (5/7 vs 0/8, P = .007) and fungal contamination of PF (3/7 vs 0/8, P = .008). Among patients with IAFI, all required an early surgical revision post-transplantation [1-18 days] and six had early or delayed pancreatic graft removal. One patient died in the first post-transplant year. CONCLUSION IAFI is a common complication in PKT, associated with pancreatic graft thrombosis or fungal contamination of the graft PF, and can sometimes lead to pancreatic detransplantation.
Collapse
Affiliation(s)
- Clara Flateau
- Service de maladies infectieuses, Groupe Hospitalier Sud Ile de France, Melun, France.,Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France
| | - Nawel Aït-Ammar
- Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Cécile Angebault
- Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Laurent Salomon
- Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'urologie, APHP, CHU Henri Mondor, Créteil, France
| | - Marie Matignon
- Service de néphrologie, APHP, CHU Henri Mondor, Créteil, France
| | - Raphaël Lepeule
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Unité Transversale du traitement des infections, Département Prévention, Diagnostic, DMU Biologie-Pathologie, APHP, CHU Henri Mondor, Créteil, France
| | - Giovanna Melica
- Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | | | - Jean-Daniel Lelièvre
- Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | - Sébastien Gallien
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France.,Service d'immunologie clinique et maladies infectieuses, APHP, CHU Henri Mondor, Créteil, France
| | - Françoise Botterel
- Groupe de Recherche et d'Etude des Maladies Infectieuses - Paris Sud-Est (GREMLIN Paris Sud-Est), Paris, France.,Unité de Parasitologie-Mycologie, Département Prévention, Diagnostic, DMU Biologie-Pathologie, CHU Henri Mondor, Assistance Publique des Hôpitaux de Paris (APHP), Créteil, France.,Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| |
Collapse
|
27
|
Ozturk M, Moore K, Kleedehn M, Ozkan O, Woods M. Percutaneous Pancreatic Duct Stent Placement for Treatment of Transplant Pancreatic Duct Stricture: Report of a Case. J Vasc Interv Radiol 2020; 31:1934-1937. [PMID: 33019994 DOI: 10.1016/j.jvir.2020.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 05/27/2020] [Accepted: 05/28/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Mesut Ozturk
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin; Department of Radiology, Ondokuz Mayis University Faculty of Medicine, 55139 Atakum, Samsun 55132, Turkey
| | - Kelli Moore
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Mark Kleedehn
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Orhan Ozkan
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Michael Woods
- Section of Interventional Radiology, Department of Radiology, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
28
|
Gopal JP, Dor FJMF, Crane JS, Herbert PE, Papalois VE, Muthusamy ASR. Anticoagulation in simultaneous pancreas kidney transplantation - On what basis? World J Transplant 2020; 10:206-214. [PMID: 32844096 PMCID: PMC7416362 DOI: 10.5500/wjt.v10.i7.206] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 03/26/2020] [Accepted: 06/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Despite technical refinements, early pancreas graft loss due to thrombosis continues to occur. Conventional coagulation tests (CCT) do not detect hypercoagulability and hence the hypercoagulable state due to diabetes is left untreated. Thromboelastogram (TEG) is an in-vitro diagnostic test which is used in liver transplantation, and in various intensive care settings to guide anticoagulation. TEG is better than CCT because it is dynamic and provides a global hemostatic profile including fibrinolysis.
AIM To compare the outcomes between TEG and CCT (prothrombin time, activated partial thromboplastin time and international normalized ratio) directed anticoagulation in simultaneous pancreas and kidney (SPK) transplant recipients.
METHODS A single center retrospective analysis comparing the outcomes between TEG and CCT-directed anticoagulation in SPK recipients, who were matched for donor age and graft type (donors after brainstem death and donors after circulatory death). Anticoagulation consisted of intravenous (IV) heparin titrated up to a maximum of 500 IU/h based on CCT in conjunction with various clinical parameters or directed by TEG results. Graft loss due to thrombosis, anticoagulation related bleeding, radiological incidence of partial thrombi in the pancreas graft, thrombus resolution rate after anticoagulation dose escalation, length of the hospital stays and, 1-year pancreas and kidney graft survival between the two groups were compared.
RESULTS Seventeen patients who received TEG-directed anticoagulation were compared against 51 contemporaneous SPK recipients (ratio of 1: 3) who were anticoagulated based on CCT. No graft losses occurred in the TEG group, whereas 11 grafts (7 pancreases and 4 kidneys) were lost due to thrombosis in the CCT group (P = 0.06, Fisher’s exact test). The overall incidence of anticoagulation related bleeding (hematoma/ gastrointestinal bleeding/ hematuria/ nose bleeding/ re-exploration for bleeding/ post-operative blood transfusion) was 17.65% in the TEG group and 45.10% in the CCT group (P = 0.05, Fisher’s exact test). The incidence of radiologically confirmed partial thrombus in pancreas allograft was 41.18% in the TEG and 25.50% in the CCT group (P = 0.23, Fisher’s exact test). All recipients with partial thrombi detected in computed tomography (CT) scan had an anticoagulation dose escalation. The thrombus resolution rates in subsequent scan were 85.71% and 63.64% in the TEG group vs the CCT group (P = 0.59, Fisher’s exact test). The TEG group had reduced blood product usage {10 packed red blood cell (PRBC) and 2 fresh frozen plasma (FFP)} compared to the CCT group (71 PRBC/ 10 FFP/ 2 cryoprecipitate and 2 platelets). The proportion of patients requiring transfusion in the TEG group was 17.65% vs 39.25% in the CCT group (P = 0.14, Fisher’s exact test). The median length of hospital stay was 18 days in the TEG group vs 31 days in the CCT group (P = 0.03, Mann Whitney test). The 1-year pancreas graft survival was 100% in the TEG group vs 82.35% in the CCT group (P = 0.07, log rank test) and, the 1-year kidney graft survival was 100% in the TEG group vs 92.15% in the CCT group (P = 0.23, log tank test).
CONCLUSION TEG is a promising tool in guiding judicious use of anticoagulation with concomitant prevention of graft loss due to thrombosis, and reduces the length of hospital stay.
Collapse
Affiliation(s)
- Jeevan Prakash Gopal
- Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, United Kingdom
| | - Frank JMF Dor
- Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, United Kingdom
- Department of Surgery and Cancer, Imperial College, London W12 0HS, United Kingdom
| | - Jeremy S Crane
- Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, United Kingdom
- Department of Surgery and Cancer, Imperial College, London W12 0HS, United Kingdom
| | - Paul E Herbert
- Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, United Kingdom
- Department of Surgery and Cancer, Imperial College, London W12 0HS, United Kingdom
| | - Vassilios E Papalois
- Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, United Kingdom
- Department of Surgery and Cancer, Imperial College, London W12 0HS, United Kingdom
| | - Anand SR Muthusamy
- Imperial College Renal and Transplant Center, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, United Kingdom
- Department of Surgery and Cancer, Imperial College, London W12 0HS, United Kingdom
| |
Collapse
|
29
|
Correlation of intraoperative donor duodenal-segment swab cultures with the subsequent occurrence of surgical site infections in kidney and pancreas transplant recipients. Infect Control Hosp Epidemiol 2020; 41:1178-1183. [PMID: 32624039 DOI: 10.1017/ice.2020.262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Pancreas transplantation is employed for the treatment of type I diabetes mellitus. It is postulated that surgical site infection (SSI), particularly organ-space infections, after pancreas transplantation may arise from microbial contamination arising from the donor duodenal segment. Therefore, some centers have adopted the practice of culturing the donor duodenal segment and subsequently administering antimicrobial therapy to the recipient directed at the microorganisms isolated to prevent SSI. METHODS In this retrospective cohort study, we evaluated the correlation between positive donor duodenal-segment cultures and SSIs in the recipients. Data were recorded and analyzed to assess the correlation of the organisms isolated in the donor duodenal cultures with those producing SSI in the recipients. RESULTS We evaluated 379 consecutive pancreas transplant recipients from January 2000 to December 2015. Donor duodenal swab cultures were performed at the time of pancreas transplantation, and 206 (54.3%) were positive. SSIs occurred in 51 of the 206 recipients (24.8%) with positive duodenal-segment cultures and in 41 of 173 individuals (23.7%) with negative cultures (P = .81; r = 0.00). Notably, deep and organ-space SSIs were observed in 27 of 206 of the positive duodenal culture groups (13.1%) versus 29 of 173 of the negative duodenal culture groups (16.8%; P = 0.31; r = -0.059). No differences were detected in the pathogens producing SSIs between the group with a positive duodenal swab versus the group with a negative swab. Microorganisms producing SSIs matched those found in the positive donor duodenal cultures in only 15 patients (7.8%). CONCLUSION Although positive cultures from the donor duodenal segment prompted the administration of antimicrobial therapy in the recipient directed against the pathogen isolated, this practice did not reduce SSIs compared with those transplant recipients with culture-negative duodenal swabs. In addition, the organisms isolated from the donor duodenal segment were not predictive of subsequent SSI.
Collapse
|
30
|
Räihä J, Helanterä I, Ekstrand A, Nordin A, Sallinen V, Lempinen M. Effect of Pretransplant Dialysis Modality on Outcomes After Simultaneous Pancreas-Kidney Transplantation. Ann Transplant 2019; 24:426-431. [PMID: 31320604 PMCID: PMC6668491 DOI: 10.12659/aot.916649] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Pretransplant dialysis modality may affect outcome after simultaneous pancreas-kidney transplantation (SPKT), and it has been suspected that peritoneal dialysis (PD) is associated with more postoperative complications compared to hemodialysis (HD). The aim of this study was to evaluate whether pretransplant dialysis modality affects the risk for postoperative complications in SPKT recipients. Material/Methods This was a retrospective longitudinal cohort study of all patients undergoing SPKT from 2010 to 2017, during which 99 simultaneous pancreas-kidney transplantations were performed. Three pre-emptive transplantations were excluded. Patient groups receiving PD (n=59) or HD (n=37) were similar regarding baseline characteristics. All complications occurring during the first 3 months after transplantation, as well as patient and graft survival, were analyzed. Results There were no significant differences in postoperative complications between groups, with similar rates of intra-abdominal infections (8% in HD vs. 10% in PD), pancreatitis (16% in HD vs. 17% in PD), gastrointestinal bleedings (22% in HD vs. 10% in PD), and relaparotomies (27% in HD vs. 24% in PD). None of the patients had venous graft thrombosis. Past peritonitis was not associated with increased risk for postoperative complications in PD patients. Patient and graft survival were similar between PD and HD groups. Conclusions Peritoneal dialysis is not a risk factor for postoperative complications after SPKT.
Collapse
Affiliation(s)
- Juulia Räihä
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ilkka Helanterä
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Agneta Ekstrand
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arno Nordin
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Ville Sallinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marko Lempinen
- Department of Transplantation and Liver Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| |
Collapse
|
31
|
Haidar G, Green M. Intra-abdominal infections in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13595. [PMID: 31102546 DOI: 10.1111/ctr.13595] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 05/11/2019] [Indexed: 02/06/2023]
Abstract
This new guideline from the AST IDCOP reviews intra-abdominal infections (IAIs), which cause substantial morbidity and mortality among abdominal SOT recipients. Each transplant type carries unique risks for IAI, though peritonitis occurs in all abdominal transplant recipients. Biliary infections, bilomas, and intra-abdominal and intrahepatic abscesses are common after liver transplantation and are associated with the type of biliary anastomosis, the presence of vascular thrombosis or ischemia, and biliary leaks or strictures. IAIs after kidney transplantation include renal and perinephric abscesses and graft-site candidiasis, which is uncommon but may require allograft nephrectomy. Among pancreas transplant recipients, duodenal anastomotic leaks can have catastrophic consequences, and polymicrobial abscesses can lead to graft loss and death. Intestinal transplant recipients are at the highest risk for sepsis, infection due to multidrug-resistant organisms, and death from IAI, as the transplanted intestine is a contaminated, highly immunological, pathogen-rich organ. Source control and antibiotics are the cornerstone of the management of IAIs. Empiric antimicrobial regimens should be tailored to local susceptibility patterns and pathogens with which the patient is known to be colonized, with subsequent optimization once the results of cultures are reported.
Collapse
Affiliation(s)
- Ghady Haidar
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Michael Green
- Departments of Pediatrics, Surgery & Clinical and Translational Science, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Division of Infectious Diseases, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | |
Collapse
|
32
|
Papachristos S, Tavakoli A, Dhanda R, Pararajasingam R, Campbell T, Forgacs B. Comparison of Ipsilateral and Contralateral Simultaneous Pancreas and Kidney Transplantation: A Single-Center Analysis with 5-Year Outcome. Ann Transplant 2019; 24:298-303. [PMID: 31123244 PMCID: PMC6556074 DOI: 10.12659/aot.912633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background It is routine to implant the pancreas on the right and the renal graft on the left iliac fossa during a simultaneous kidney and pancreas transplant (cSPK). Ipsilateral placement of both organs on the same side raises concerns that the pancreas graft might compromise the distally placed kidney. However, ipsilateral SPK (iSPK) can be faster than the conventional contralateral graft placement and allows for preservation of the other side for future transplants. Material/Methods In a single unit, 67 SPK transplantations (cSPK n=49, iSPK n=18) were performed from 2008 to 2011. The decision for graft placement was made during the procedure. Donor and recipient demographics, surgical complications, reoperations, surgical time, and patient and graft survival with 5-year follow-up were compared between the 2 groups. Results Duration of operation was shorter in the iSPK group. Recipient and donor demographics were comparable, apart from more females receiving ipsilateral graft placement. The broader female pelvis was probably the determining factor contributing to this outcome. The iSPK group included marginally younger recipients. The ipsilateral group also demonstrated a trend to improved survival of patient, pancreas, and kidney graft, at 1- and 5-year follow-up. There was no difference in complication rates between the 2 groups. Conclusions There were no significant differences in overall outcomes. iSPK is a safe procedure, which proves similar patient and graft survival as with cSPK. Both procedures have comparable surgical complication rates. iSPK is a safe and quicker procedure that allows for preservation of the contralateral side for potential subsequent transplants.
Collapse
Affiliation(s)
- Stavros Papachristos
- Department of Transplantation Surgery, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Afshin Tavakoli
- Department of Transplantation Surgery, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Raman Dhanda
- Department of Transplantation Surgery, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Ravi Pararajasingam
- Department of Transplantation Surgery, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Tunde Campbell
- Department of Transplantation Surgery, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - Bence Forgacs
- Department of Transplantation Surgery, Manchester Royal Infirmary, Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| |
Collapse
|
33
|
Thompson ER, Irwin EA, Trotter P, Ibrahim IK, Tingle SJ, White SA, Manas DM, Wilson CH. UK registry analysis of donor substance misuse and outcomes following pancreas transplantation. Clin Transplant 2019; 33:e13481. [DOI: 10.1111/ctr.13481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/17/2018] [Accepted: 01/11/2019] [Indexed: 01/22/2023]
Affiliation(s)
- Emily R. Thompson
- NIHR Blood and Transplant Research Unit Institute of Transplantation, Freeman Hospital Newcastle upon Tyne UK
| | - Ellen A. Irwin
- NIHR Blood and Transplant Research Unit Institute of Transplantation, Freeman Hospital Newcastle upon Tyne UK
| | - Patrick Trotter
- NIHR Blood and Transplant Research Unit, Department of Surgery University of Cambridge, Addenbrookes Hospital Cambridge UK
| | - Ibrahim K. Ibrahim
- NIHR Blood and Transplant Research Unit Institute of Transplantation, Freeman Hospital Newcastle upon Tyne UK
| | - Sam J. Tingle
- NIHR Blood and Transplant Research Unit Institute of Transplantation, Freeman Hospital Newcastle upon Tyne UK
| | - Steve A. White
- NIHR Blood and Transplant Research Unit Institute of Transplantation, Freeman Hospital Newcastle upon Tyne UK
| | - Derek M. Manas
- NIHR Blood and Transplant Research Unit Institute of Transplantation, Freeman Hospital Newcastle upon Tyne UK
| | - Colin H. Wilson
- NIHR Blood and Transplant Research Unit Institute of Transplantation, Freeman Hospital Newcastle upon Tyne UK
| |
Collapse
|
34
|
Serrano OK, Wagner SL, Sun S, Kandaswamy R. Preneoplastic Lesion in a Pancreas Allograft: Dilemma for the Pancreas Transplant Surgeon. Transplant Proc 2018; 50:3694-3697. [PMID: 30577257 DOI: 10.1016/j.transproceed.2018.06.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 06/27/2018] [Indexed: 11/24/2022]
Abstract
Although the relationship between immunosuppression and cancer risk is well-documented, the association between immunosuppression and the development of preneoplastic lesions (PNL) is less clear. PNLs pose a unique clinical conundrum in the transplanted pancreas because their prevalence in the general population is not infrequent. We present the case of a 58-year-old man with a history of diabetes mellitus type 1 who underwent successful pancreas transplantation with bladder drainage. His kidney function failed 13 years after his transplant and he developed recurrent painful hematuria with symptomatic anemia 2 years after initiating hemodialysis. Upon work-up, he was found to have a 4 cm intraductal papillary mucinous neoplasm in his pancreas allograft. At his enteric conversion, the intraductal papillary mucinous neoplasm was removed through a distal pancreatectomy due to concern for its malignant potential. He recovered well from surgery and continues to be insulin-free. With the rising incidence of PNLs from improved detection and the improved survival of pancreas allografts, the implications of PNLs may be more pronounced in the future. This case raises several important considerations for the pancreas transplant surgeon regarding adequate allograft surveillance protocols, treatment, and follow-up.
Collapse
Affiliation(s)
- O K Serrano
- Division of Transplantation, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN.
| | - S L Wagner
- Division of Transplantation, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN; Marian University College of Osteopathic Medicine, Indianapolis, IN
| | - S Sun
- Division of Transplantation, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN; Division of Transplantation, Karolinska Institutet, Huddinge, Sweden
| | - R Kandaswamy
- Division of Transplantation, Department of Surgery, University of Minnesota Medical School, Minneapolis, MN
| |
Collapse
|
35
|
Li J, Koch M, Kramer K, Kloth K, Abu Ganim AR, Scheidat S, Rinninger F, Thaiss F, Gulati A, Herden U, Achilles E, Fischer L, Nashan B. Dual antibody induction and de novo use of everolimus enable low-dose tacrolimus with early corticosteroid withdrawal in simultaneous pancreas-kidney transplantation. Transpl Immunol 2018; 50:26-33. [DOI: 10.1016/j.trim.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 05/27/2018] [Accepted: 06/01/2018] [Indexed: 12/28/2022]
|
36
|
Marmanillo CG, Langaro C, Nicoluzzi JE, Belila RT, Macri M, Zamprogna R, Luvizotto M, Takahashi M. Renopancreatic Transplantation: Evaluation of 15 Years in 131 Patients. Transplant Proc 2018; 50:792-795. [PMID: 29661440 DOI: 10.1016/j.transproceed.2018.02.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The most common multiple-organ transplant is the simultaneous pancreas-kidney transplantation (SPK). It is usually offered to patients who have insulin-dependent diabetes mellitus and those with diabetic nephropathy and renal failure that has already been established. In this study we present the results of 15 years of SPK in a transplant hospital center in Paraná, Brazil, and evaluated survival, immunosuppression, and transplant-related problems. METHODS This study was a retrospective analysis of 131 SPK transplants performed at the Angelina Caron Hospital between January 2001 and December 2015. RESULTS The mean age of SPK recipients was 34 years, with slight a predominance of males (50.4%). Mean graft ischemia time was 11 hours. Exocrine drainage was predominantly vesical, but this approach was abandoned after 2011. As for immunosuppression, induction was performed with basiliximab or thymoglobulin and maintained with prednisone, mycophenolate mofetil, tacrolimus, and/or sirolimus. Patient survival increased from 68.1% in 2001 to 2005 to 77.6% in 2011 to 2015. Graft survival at the end of the period was 85.7% for kidney and 75.5% for pancreas. The main surgery-derived problems for pancreas and kidney was thrombosis (15% and 6%, respectively). The main clinical problems were rejection of the pancreas (18.3%) and urinary infection of the kidney (33.3%). The main cause of death was intra-abdominal sepsis (11.4%). CONCLUSION There was an improvement in survival rates over the time frame observed, but it remains necessary to adopt measures to reduce transplant-derived problems, including review of the antibiotic therapy protocol and measures to avoid graft thrombosis.
Collapse
Affiliation(s)
- C G Marmanillo
- Department of Nefrology, Angelina Caron Hospital, Campina Grande do Sul, Paraná, Brazil.
| | - C Langaro
- Department of Nefrology, Angelina Caron Hospital, Campina Grande do Sul, Paraná, Brazil
| | - J E Nicoluzzi
- Department of Nefrology, Angelina Caron Hospital, Campina Grande do Sul, Paraná, Brazil
| | - R T Belila
- Department of Nefrology, Angelina Caron Hospital, Campina Grande do Sul, Paraná, Brazil
| | - M Macri
- Department of Nefrology, Angelina Caron Hospital, Campina Grande do Sul, Paraná, Brazil
| | - R Zamprogna
- Department of Nefrology, Angelina Caron Hospital, Campina Grande do Sul, Paraná, Brazil
| | - M Luvizotto
- Department of Nefrology, Angelina Caron Hospital, Campina Grande do Sul, Paraná, Brazil
| | - M Takahashi
- Department of Nefrology, Angelina Caron Hospital, Campina Grande do Sul, Paraná, Brazil
| |
Collapse
|
37
|
Gasteiger S, Cardini B, Göbel G, Oberhuber R, Messner F, Resch T, Bösmüller C, Margreiter C, Schneeberger S, Maglione M. Outcomes of pancreas retransplantation in patients with pancreas graft failure. Br J Surg 2018; 105:1816-1824. [PMID: 30007018 PMCID: PMC6282534 DOI: 10.1002/bjs.10929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2017] [Revised: 03/17/2018] [Accepted: 06/01/2018] [Indexed: 12/23/2022]
Abstract
Background Pancreas 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. Methods This 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. Results Of 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. Conclusion Pancreas retransplantation may be considered for patients whose previous graft has failed. Good outcome in selected patients
Collapse
Affiliation(s)
- S Gasteiger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - B Cardini
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - G Göbel
- Department of Medical Statistics, Informatics and Health Economics, Medical University of Innsbruck, Innsbruck, Austria
| | - R Oberhuber
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - F Messner
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - T Resch
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C Bösmüller
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - C Margreiter
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - S Schneeberger
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - M Maglione
- Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| |
Collapse
|
38
|
Pieroni E, Napoli N, Lombardo C, Marchetti P, Occhipinti M, Cappelli C, Caramella D, Consani G, Amorese G, De Maria M, Vistoli F, Boggi U. Duodenal graft complications requiring duodenectomy after pancreas and pancreas-kidney transplantation. Am J Transplant 2018; 18:1388-1396. [PMID: 29205793 DOI: 10.1111/ajt.14613] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/02/2017] [Accepted: 11/21/2017] [Indexed: 01/25/2023]
Abstract
Duodenal graft complications are poorly reported complications of pancreas transplantation that can result in graft loss. Excluding patients with early graft failure, after a median follow-up period of 126 months (range 23-198) duodenectomy was required in 14 of 312 pancreas transplants (4.5%). All patients were insulin-independent at the time of diagnosis. Reasons for duodenectomy included delayed duodenal graft perforation (n = 10, 71.5%) and refractory duodenal graft bleeding (n = 4, 28.5%). In patients with duodenal graft bleeding, a total duodenectomy was performed. In patients with duodenal graft perforation, preservation of a duodenal segment was possible in five patients but completion duodenectomy was necessary in one patient. After total duodenectomy, immediate enteric duct drainage was feasible in seven patients. In two patients, a pancreaticocutaneous fistula was created that was subsequently converted to enteric drainage in one patient. In the other patient, enteric fistulization occurred as a consequence of silent pressure perforation of the draining catheter on the ascending colon. After a mean follow-up period of 52 months (21-125), all patients were alive, well, and insulin-independent. An aggressive and timely surgical approach may permit graft rescue in patients with severe duodenal graft complications occurring after pancreas transplantation. Generalization of these results remains to be established.
Collapse
Affiliation(s)
- Erica Pieroni
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Niccolò Napoli
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Carlo Lombardo
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Piero Marchetti
- Division of Metabolism and Cell Transplantation, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Margherita Occhipinti
- Division of Metabolism and Cell Transplantation, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Carla Cappelli
- Division of Radiology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Davide Caramella
- Division of Radiology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Giovanni Consani
- Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Gabriella Amorese
- Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Maurizio De Maria
- Division of Urology, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Fabio Vistoli
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, Azienda Ospedaliero Universitaria Pisana, University of Pisa, Pisa, Italy
| |
Collapse
|
39
|
Sánchez-Hidalgo JM, Salamanca-Bustos JJ, Arjona-Sánchez Á, Campos-Hernández JP, Ruiz Rabelo J, Rodríguez-Benot A, Requena-Tapia MJ, Briceño-Delgado J. What Is the Influence of Both Risk Donor and Risk Receiver on Simultaneous Pancreas-Kidney Transplantation? Transplant Proc 2018; 50:664-668. [PMID: 29579883 DOI: 10.1016/j.transproceed.2017.09.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/21/2017] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Some factors affect the pancreas of a marginal donor, and although their influence on graft survival has been determined, there is an increasing consensus to accept marginal organs in a controlled manner to increase the pool of organs. Certain factors related to the recipient have also been proposed as having negative influence on graft prognosis. The objective of this study was to analyze the influence of these factors on the results of our simultaneous pancreas-kidney (SPK) transplantation series. MATERIALS AND METHODS Retrospective analysis of 126 SPK transplants. Donors and recipients were stratified in an optimal group (<2 expanded donor criteria) and a risk group (≥2 criteria). A pancreatic graft survival analysis was performed using a Kaplan-Meier test and log-rank test. Prognostic variables on graft survival were studied by Cox regression. Postoperative complications (graded by Clavien classification) were compared by χ2 test or Fisher test. RESULTS Median survival of pancreas was 66 months, with no significant difference between groups (P > .05). Multivariate analysis showed risk factors to be donor age, cold ischemia time, donor body mass index, receipt body mass index, and receipt panel-reactive antibody. CONCLUSIONS In our series, the use of pancreatic grafts from donors with expanded criteria is safe and has increased the pool of grafts. Different variables, both donor and recipient, influence the survival of the pancreatic graft and should be taken into account in organ distribution systems.
Collapse
Affiliation(s)
| | | | - Á Arjona-Sánchez
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | | | - J Ruiz Rabelo
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| | - A Rodríguez-Benot
- Department of Nephrology, University Hospital Reina Sofia, Córdoba, Spain
| | - M J Requena-Tapia
- Department of Urology, University Hospital Reina Sofia, Córdoba, Spain
| | - J Briceño-Delgado
- Department of Surgery, University Hospital Reina Sofia, Córdoba, Spain
| |
Collapse
|
40
|
Development and results of a novel pancreas transplant program in Spain: the surgeon's point of view. Cir Esp 2018; 96:205-212. [PMID: 29501238 DOI: 10.1016/j.ciresp.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 10/13/2017] [Accepted: 12/31/2017] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Simultaneous kidney-pancreas transplantation for patients with type 1 diabetes and end-stage chronic renal disease is widely performed. However, the rate of surgical morbidity from pancreatic complications remains high. The aim of this study was to describe the development and results of a new program, from the point of view of the pancreatic surgeon. METHODS We analyzed 53 simultaneous kidney-pancreas transplantations performed over a period of seven years (2009-2016), with a median follow up of 39 months (range: 1-86 months). RESULTS Out of the total of this series, two patients died: one patient because of cardiac arrest immediately after surgery; and another patient due to traffic accident, complicated by pneumonia. Among the 51 living patients, two grafts were lost: one due to chronic rejection four years after transplantation; and the other due to arterial thrombosis 20 days after transplantation (the only case requiring transplantectomy). In ten patients, one or more re-operations were necessary due to the following: graft pancreatitis (n=4), small intestinal obstruction (n=4), arterial thrombosis (n=1), fistula (n=1) and hemoperitoneum (n=1). Overall patient and graft survival rates after 1, 3 and 5 years were 98, 95 and 95% and 96, 93 and 89%, respectively. CONCLUSIONS This study has shown that the results of a new pancreas transplant program, which relies on the previous experience of other groups, do not demonstrate a learning curve. Adequate surgeon education and training, as well as the proper use of standardized techniques, should ensure optimal results.
Collapse
|
41
|
Harbell JW, Morgan T, Feldstein VA, Roll GR, Posselt A, Kang SM, Feng S, Hirose R, Freise CE, Stock P. Splenic Vein Thrombosis Following Pancreas Transplantation: Identification of Factors That Support Conservative Management. Am J Transplant 2017; 17:2955-2962. [PMID: 28707821 DOI: 10.1111/ajt.14428] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/14/2017] [Accepted: 07/03/2017] [Indexed: 01/25/2023]
Abstract
Prophylaxis for graft portal/splenic venous thrombosis following pancreas transplant varies between institutions. Similarly, treatment of venous thrombosis ranges from early re-exploration to conservative management with anticoagulation. We wished to determine the prevalence of graft splenic vein (SV) thrombosis, as well as the clinical significance of non-occlusive thrombus observed on routine imaging. Records of 112 pancreas transplant recipients over a 5-year period at a single center were reviewed. Venous thrombosis was defined as absence of flow or presence of thrombus identified in any part of the graft SV on ultrasound. Thirty patients (27%) had some degree of thrombus or absence of flow in the SV on postoperative ultrasound. There were 5 graft losses in this group. Four were due to venous thrombosis, and occurred within 20 days of transplant. All patients with non-occlusive partial SV thrombus but normal arterial signal on Doppler ultrasound were successfully treated with IV heparin followed by warfarin for 3-6 months, and remained insulin independent. Findings of arterial signal abnormalities, such as absence or reversal of diastolic flow within the graft, require urgent operative intervention since this finding can be associated with more extensive thrombus that may lead to graft loss.
Collapse
Affiliation(s)
- J W Harbell
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - T Morgan
- Department of Radiology, University of California San Francisco, San Francisco, CA
| | - V A Feldstein
- Department of Radiology, University of California San Francisco, San Francisco, CA
| | - G R Roll
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - A Posselt
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - S-M Kang
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - S Feng
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - R Hirose
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - C E Freise
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA
| | - P Stock
- Division of Transplantation, Department of Surgery, University of California San Francisco, San Francisco, CA
| |
Collapse
|
42
|
Portal Vein Thrombosis After Splenic and Pancreatic Surgery. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 906:241-251. [PMID: 27638624 DOI: 10.1007/5584_2016_119] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The portal vein is formed by the confluence of the splenic and superior mesenteric veins, which drain the spleen and small intestine respectively. Occlusion of the portal vein by thrombus typically occurs in patients with cirrhosis and/or prothrombotic disorders. However, portal vein thrombosis (PVT) can also happen after determined surgeries. Moreover, PVT can have serious consequences depending on the location and extent of the thrombosis, including hepatic ischemia, intestinal ischemia, portal hypertension… In this chapter, we will review the incidence, management and prophylaxis of PVT after splenectomy, pancreas transplantation, pancreatic surgery and in the setting of acute and chronic pancreatitis.
Collapse
|
43
|
Ferrer J, Molina V, Rull R, López-Boado MÁ, Sánchez S, García R, Ricart MJ, Ventura-Aguiar P, García-Criado Á, Esmatjes E, Fuster J, Garcia-Valdecasas JC. Pancreas transplantation: Advantages of a retroperitoneal graft position. Cir Esp 2017; 95:513-520. [PMID: 28688516 DOI: 10.1016/j.ciresp.2017.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 05/14/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION In the 50 years since the first pancreas transplant performed at the University of Minnesota, the surgical techniques employed have undergone many modifications. Techniques such as retroperitoneal graft placement have further improved the ability to reproduce the physiology of the «native» pancreas. We herein present our experience of a modified technique for pancreatic transplant, with the organ placed into a fully retroperitoneal position with systemic venous and enteric drainage of the graft by duodeno-duodenostomy. METHODS All pancreas transplantations performed between May 2016 and January 2017 were prospectively entered into our transplant database and retrospectively analyzed. RESULTS A total of 10 transplants were performed using the retroperitoneal technique (6 men: median age of 41 years [IQR 36-54]). Median cold ischemia times was 10,30h [IQR 5,30-12,10]. The preservation solution used was Celsior (n=7), IGL-1 (n=2), and UW (n=1). No complications related to the new surgical technique were identified. In one patient, transplantectomy at 12h was performed due to graft thrombosis, probably related to ischemic conditions from a donor with prolonged cardio-respiratory arrest. Another procedure was aborted without completing the graft implant due to an intraoperative immediate arterial thrombosis in a patient with severe iliac atheromatosis. No primary pancreas non-function occurred in the remaining 8patients. The median hospital stay was 13,50 days [IQR 10-27]. CONCLUSIONS Retroperitoneal graft placement appears feasible with easy access for dissection the vascular site; comfortable technical vascular reconstruction; and a decreased risk of intestinal obstruction by separation of the small bowel from the pancreas graft.
Collapse
Affiliation(s)
- Joana Ferrer
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España.
| | - Víctor Molina
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Ramón Rull
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Miguel Ángel López-Boado
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Santiago Sánchez
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Rocío García
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Ma José Ricart
- Unidad de Trasplante Renal, Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Pedro Ventura-Aguiar
- Unidad de Trasplante Renal, Servicio de Nefrología y Trasplante Renal, Hospital Clínic, Barcelona, España
| | - Ángeles García-Criado
- Servicio de Radiología, Centro de Diagnóstico por la Imagen, Hospital Clínic, Barcelona, España
| | - Enric Esmatjes
- Unidad de Diabetes, Servicio de Endocrinología y Nutrición, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Barcelona, España
| | - Josep Fuster
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| | - Juan Carlos Garcia-Valdecasas
- Cirugía Hepatobiliopancreática y Trasplante Hepático y Pancreático, Instituto de Enfermedades Metabólicas y Digestivas, Hospital Clínic, Universidad de Barcelona, Barcelona, España
| |
Collapse
|
44
|
Salamanca-Bustos JJ, Campos-Hernandez JP, Sánchez-Hidalgo JM, Arjona-Sánchez A, Sánchez-González A, Arenas-Bonilla AJ, Ruiz-Rabelo J, Carrasco-Valiente J, Ruiz-García J, Regueiro-López JC, Briceño-Delgado J, Requena-Tapia MJ. Validation of the Pancreatic Donor Risk Index in Simultaneous Pancreas-Kidney Transplantation Performed in Córdoba Hospital From 2000 to 2015. Transplant Proc 2017; 48:3037-3039. [PMID: 27932141 DOI: 10.1016/j.transproceed.2016.07.049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 07/27/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Pancreatic Donor Risk Index (PDRI) was developed in 2010 in the United States to predict graft survival after pancreas transplantation, based on donor characteristics and logistical and technical conditions. The aim of the study was to validate the utility of PDRI as a pancreas allograft survival predictor in simultaneous pancreas-kidney transplantation (SPK) transplants performed in our hospital between 2000 and 2015. METHODS This retrospective analysis of 126 SPK transplants was performed by the same surgical team from the years 2000 to 2015. Donor variables that are integrated in the PDRI were calculated (age, sex, race, creatinine serum levels, body mass index, height, cold ischemia time, cause of death, type of pancreas transplant). Pancreatic graft survival at 1 and 5 years was calculated by use of the Kaplan-Meier test. Comparison of survival curves between PDRI risk quartiles was calculated by use of the log-rank test. Association between graft survival and variables integrating the PDRI was calculated by use of univariate Cox regression analysis. RESULTS Log-rank analysis found no statistically significant association between global graft survival and PDRI quartiles. Univariate Cox regression analysis showed a statistically significant association between graft survival and cold ischemia time (P < .05). CONCLUSIONS PDRI was not a useful tool to predict pancreatic graft outcomes in a Spanish reference population.
Collapse
Affiliation(s)
| | | | | | - A Arjona-Sánchez
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | | | | | - J Ruiz-Rabelo
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | | | - J Ruiz-García
- Department of Urology, University Hospital Reina Sofía, Córdoba, Spain
| | | | - J Briceño-Delgado
- Department of Surgery, University Hospital Reina Sofía, Córdoba, Spain
| | - M J Requena-Tapia
- Department of Urology, University Hospital Reina Sofía, Córdoba, Spain
| |
Collapse
|
45
|
The center volume-outcome effect in pancreas transplantation: a national analysis. J Surg Res 2017; 213:25-31. [PMID: 28601322 DOI: 10.1016/j.jss.2017.02.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/27/2016] [Accepted: 02/17/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Although increased hospital volume has been correlated with improved outcomes in certain surgical procedures, the effect of center volume on pancreas transplantation (PT) is less understood. Our study aims to establish whether a volume-outcome effect exists for PT. METHODS Through an established linkage between the University HealthSystem Consortium and the Scientific Registry of Transplant Recipients (SRTR) databases, we performed a retrospective cohort analysis of adult PT recipients between 2009 and 2012. Surgical volume was divided equally into low volume (LV), middle volume (MV), and high volume (HV) tertiles for each year that was studied. Hospital outcomes were measured through University HealthSystem Consortium, and long-term outcomes were measured through Scientific Registry of Transplant Recipients. Statistical analysis was performed using regression analyses and the Kaplan-Meier method. Median follow-up period was 2 y. RESULTS Among the 2309 PT recipients included, 815 (35.3%) were performed at LV centers, 755 (32.7%) at MV centers, and 739 (32.0%) at HV centers. Compared with MV and LV centers, organs transplanted at HV centers were more frequently donation after cardiac death (5.1% versus 2.4% versus 3.3%, P = 0.01) and from older donors (2.8% [>50 y] versus 0.8% versus 0.1%, P < 0.001). In addition, HV recipients were older (31.5% [>50 y] versus 20.9% versus 19.7%, P < 0.001) and had worse functional status (39.5% dependent versus 9.7% versus 9.9%, P < 0.001). Patient and graft survival were similar across hospital volume tertiles. Center volume was not predictive of readmission rates, total length of stay, intensive care unit length of stay, or total direct cost on multivariate analysis (all P > 0.05). CONCLUSIONS Short- and long-term outcomes after PT are not affected by hospital volume. Although LV centers confine their cases to low-risk patients, HV centers transplant a higher percentage of high-risk donor and recipient combinations with equivalent outcomes.
Collapse
|
46
|
Surgical complications after simultaneous pancreas-kidney transplantation: A single-center experience. Asian J Surg 2016; 39:232-7. [PMID: 26857852 DOI: 10.1016/j.asjsur.2015.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/06/2015] [Accepted: 11/09/2015] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND We investigated the rate of early surgical complications after simultaneous pancreas-kidney transplantation (SPKT) and their impact on both grafts and recipient survival. MATERIALS AND METHODS The retrospective analysis of typical pancreas-related complications, different methods of correction, and their efficacy were performed. Data describing pancreas transplant recipients were drawn from our SPKT waiting list. RESULTS The overall surgical complications rate was 37.5%. The 1-year pancreas graft survival was 82.5% and 1-year recipient survival was 90%. Surgical complications based on the graft loss rate did not exceed 2.5%. Direct surgical complications did not account for the loss of a single patient. CONCLUSION We conclude that the high rate of surgical complications is a major obstacle to widespread application of pancreas transplantation; early recognition and appropriate treatment of graft-related complications is fundamental for graft survival.
Collapse
|
47
|
Song S, Roy S. Progress and challenges in macroencapsulation approaches for type 1 diabetes (T1D) treatment: Cells, biomaterials, and devices. Biotechnol Bioeng 2016; 113:1381-402. [PMID: 26615050 DOI: 10.1002/bit.25895] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 10/30/2015] [Accepted: 11/24/2015] [Indexed: 12/15/2022]
Abstract
Macroencapsulation technology has been an attractive topic in the field of treatment for Type 1 diabetes due to mechanical stability, versatility, and retrievability of the macro-capsule design. Macro-capsules can be categorized into extravascular and intravascular devices, in which solute transport relies either on diffusion or convection, respectively. Failure of macroencapsulation strategies can be due to limited regenerative capacity of the encased insulin-producing cells, sub-optimal performance of encapsulation biomaterials, insufficient immunoisolation, excessive blood thrombosis for vascular perfusion devices, and inadequate modes of mass transfer to support cell viability and function. However, significant technical advancements have been achieved in macroencapsulation technology, namely reducing diffusion distance for oxygen and nutrients, using pro-angiogenic factors to increase vascularization for islet engraftment, and optimizing membrane permeability and selectivity to prevent immune attacks from host's body. This review presents an overview of existing macroencapsulation devices and discusses the advances based on tissue-engineering approaches that will stimulate future research and development of macroencapsulation technology. Biotechnol. Bioeng. 2016;113: 1381-1402. © 2015 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Shang Song
- Department of Bioengineering and Therapeutic Sciences, University of California-San Francisco, San Francisco, California 94158
| | - Shuvo Roy
- Department of Bioengineering and Therapeutic Sciences, University of California-San Francisco, San Francisco, California 94158.
| |
Collapse
|
48
|
Shah AP, Chen JM, Fridell JA. Incidence and outcomes of cytomegalovirus in pancreas transplantation with steroid-free immunosuppression. Clin Transplant 2015; 29:1221-9. [DOI: 10.1111/ctr.12655] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Ashesh P. Shah
- Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| | - Jeanne M. Chen
- Department of Pharmacy; Indiana University Health-University Hospital; Indianapolis IN USA
| | - Jonathan A. Fridell
- Department of Surgery; Indiana University School of Medicine; Indianapolis IN USA
| |
Collapse
|
49
|
Meirelles Júnior RF, Salvalaggio P, Pacheco-Silva A. Pancreas transplantation: review. EINSTEIN-SAO PAULO 2015; 13:305-9. [PMID: 26154551 PMCID: PMC4943828 DOI: 10.1590/s1679-45082015rw3163] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 02/08/2015] [Indexed: 12/20/2022] Open
Abstract
Vascularized pancreas transplantation is the only treatment that establishes normal glucose levels and normalizes glycosylated hemoglobin levels in type 1 diabetic patients. The first vascularized pancreas transplant was performed by William Kelly and Richard Lillehei, to treat a type 1 diabetes patient, in December 1966. In Brazil, Edison Teixeira performed the first isolated segmental pancreas transplant in 1968. Until the 1980s, pancreas transplants were restricted to a few centers of the United States and Europe. The introduction of tacrolimus and mycophenolate mofetil in 1994, led to a significant outcome improvement and consequently, an increase in pancreas transplants in several countries. According to the International Pancreas Transplant Registry, until December 31st, 2010, more than 35 thousand pancreas transplants had been performed. The one-year survival of patients and pancreatic grafts exceeds 95 and 83%, respectively. The better survival of pancreatic (86%) and renal (93%) grafts in the first year after transplantation is in the simultaneous pancreas-kidney transplant group of patients. Immunological loss in the first year after transplant for simultaneous pancreas-kidney, pancreas after kidney, and pancreas alone are 1.8, 3.7, and 6%, respectively. Pancreas transplant has 10 to 20% surgical complications requiring laparotomy. Besides enhancing quality of life, pancreatic transplant increases survival of uremic diabetic patient as compared to uremic diabetic patients on dialysis or with kidney transplantation alone.
Collapse
|
50
|
Abstract
Simultaneous pancreas-kidney transplantation (SPKT) is now accepted as the method of choice for patients with insulin-dependent diabetes mellitus (type I) who have end-stage renal disease (ESRD). We believe that retroperitoneal positioning of the donor pancreas with the formation of duodeno-duodenal anastomosis is the most physiologically relevant. Starting in January 2008, the SPKT was chosen as the treatment method of 32 patients with diabetes mellitus. In 15 cases comprising group I (46.9%), the pancreas was placed intra-abdominally (including the formation of the duodeno-jejunal anastomosis). In the remaining 17 patients (53.1%) comprising group II, the pancreas was positioned retroperitoneally (including the formation of the duodeno-duodenal anastomosis). We compared the main parameters of the early postoperative period in these groups. There were no substantial differences between the groups in the prevalence of immunological (13.3% and 11.8%, P = .9), surgical (20% and 23.5%, P = .81), and infectious complications (20% and 5.9%, P = .23). On discharge there were no significant differences in the values of the following between the two groups, respectively: serum creatinine values, 112.7 ± 31.2 and 104.8 ± 54.6 μmol/L, P = .17; glomerular filtration rate, 73.5 ± 28.6 and 78.7 ± 24.9 mL/min, P = .55; α-amylase, 121.9 ± 63.6 and 150.1 ± 72.1 U/L, P = .27; pancreatic amylase, 102 ± 51.5 and 122.5 ± 75.4 U/L, P = .6; lipase, 115.4 ± 67.3 and 96 ± 65.7 U/L, P = .5; С-peptide, 4.44 ± 1.9 and 4.02 ± 2.4 ng/mL, P = .47; HbA1c, 5.45 ± 0.8% and 5.56 ± 1.12%, P = .9; and intact insulin, 12.2 ± 5.4 and 12.9 ± 8.8 mcIU/mL, P = .95). SPKT remains the best method of medical and social rehabilitation for patients who have diabetes mellitus (type-I) with ESRD. Compared to the classic method, we have seen no significant deviations in either of the following: the qualitative features marking the restoration of function of the two transplanted organs and/or the quality of compensation of carbohydrate metabolism, incidence of rejection, and graft loss. At the same time, retroperitoneal positioning of the pancreas exhibited lower repeat surgery rates.
Collapse
|