1
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Owen-Simon NL, Dube GK, Sandoval PR, Ratner LE, McCune K. When pancreata fly: Outcomes and lessons learned from the development of a Pancreas Transplant Import Program. Clin Transplant 2023; 37:e15061. [PMID: 37395950 DOI: 10.1111/ctr.15061] [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: 02/28/2023] [Revised: 06/03/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND To address long waitlist times and increase pancreas transplantation, our center has implemented a protocol for long-distance importation of pancreata. METHODS We conducted a retrospective review of pancreas transplantation at our institution from January 1, 2014, the start of our importation program, through September 30, 2021. Outcomes were compared between locally procured grafts and imported grafts, defined as grafts procured greater than 250 nautical miles (NM) from our center. RESULTS Eighty-one patients underwent pancreas transplantation during the study time period; 19 (23.5%) received imported grafts. There were no significant differences in recipient demographics or type of transplant received. Mean distance of import was 644.2 ± 234.0 NM. Imported grafts were more likely to be from pediatric donors <18 years old (p = .02) and a significantly higher proportion of imported grafts came from donors weighing <30 kg (26.3 vs. 3.2%, p = .007). Cold ischemic time was longer for imported grafts than for local grafts (13.4 ± 2.3 h vs. 9.8 ± 2.2 h, p < .01). There was no significant difference in deaths or graft losses within 90 days or at 1 year between groups. CONCLUSION Centers should consider expanding criteria for acceptance of imported pancreata to increase the number of transplants and combat organ nonutilization.
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Affiliation(s)
- Nina L Owen-Simon
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Geoffrey K Dube
- Department of Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - Pedro Rodrigo Sandoval
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Lloyd E Ratner
- Department of Surgery, Columbia University Irving Medical Center, New York, New York, USA
| | - Kasi McCune
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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2
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Yoo A, Riedel A, Qian I, Bartosic A, Soltani R, Kibria G, Haririan A, Drachenberg CB, Abrams PL, Odorico JS, Cooper M, Bromberg JS, Scalea JR. An Initial Analysis of the Baseline Levels of Dd-cfDNA After Pancreas Transplantation: A Prospective Study From High-volume Centers in the United States. Transplant Direct 2023; 9:e1459. [PMID: 36935870 PMCID: PMC10019258 DOI: 10.1097/txd.0000000000001459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 01/19/2023] [Accepted: 01/22/2023] [Indexed: 03/17/2023] Open
Abstract
Pancreas transplantation offers patients with diabetes an opportunity for glucose homeostasis. Current blood tests to surveil for rejection have poor sensitivity and specificity for identifying rejection, and pancreas biopsies are challenging and associated with morbidity and graft loss. Donor-derived cell-free DNA (dd-cfDNA) is shed from transplanted organs and detectable in peripheral blood. Thus, a potential dd-cfDNA blood test assessing rejection would be clinically advantageous. Methods One hundred eighty-one dd-cfDNA samples (n) were collected from 77 patients (N) up to 132 mo posttransplant. Results The median dd-cfDNA level among all subjects was 0.28% (0.13%, 0.71%). In simultaneous pancreas-kidney (SPK) transplant recipients, the median dd-cfDNA level was 0.29% (0.13%, 0.71%), and it was 0.23% (0.08%, 0.71%) in pancreas transplant alone (PTA) recipients. When isolating for when without infection or rejection, the median dd-cfDNA level was 0.28% (0.13%, 0.64%) for SPK and 0.20% (0.00%, 0.32%) for PTA. Both transplant types approached 1.0% ≤1 mo posttransplant followed by a decrease in median dd-cfDNA. During episodes of rejection or infection, median dd-cfDNA levels were greater among all transplant types. Conclusions The mean dd-cfDNA level for all pancreas transplant recipients is <1.0%, consistent with the published kidney transplant rejection threshold (>1.0%), regardless of SPK or PTA. Early posttransplant dd-cfDNA levels are transiently higher than later measurements. Dd-cfDNA elevation also correlates with rejection and infection and thus is a promising biomarker for surveilling pancreas transplant dysfunction.
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Affiliation(s)
- Ashley Yoo
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Alexandria Riedel
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Ian Qian
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Amanda Bartosic
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Rudi Soltani
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Gulam Kibria
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Abdolreza Haririan
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Cinthia B. Drachenberg
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | | | - Jon S. Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | | | - Jonathan S. Bromberg
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Joseph R. Scalea
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
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3
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Higher Fasting Pretransplant C-peptide Levels in Type 2 Diabetics Undergoing Simultaneous Pancreas-kidney Transplantation Are Associated With Posttransplant Pancreatic Graft Dysfunction. Transplantation 2023; 107:e109-e121. [PMID: 36706060 DOI: 10.1097/tp.0000000000004489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Among selected patients with type 2 diabetes mellitus (T2DM), simultaneous pancreas and kidney (SPK) transplants can be an effective option. However, data are limited about outcomes in T2DM SPK recipients based on the pretransplant C-peptide levels. METHODS In this study, we reviewed all T2DM SPK recipients and categorized them based on the pretransplant fasting C-peptide levels into 3 groups: low (≤2 ng/mL), medium (>2-8 ng/mL), and high (>8 ng/mL). Several measures of graft failures (GFs), graft dysfunction, and composite outcomes were of interest. RESULTS There were a total of 76 SPK recipients (low, n = 14; medium, n = 47; high, n = 15). At the last follow-up, the low group did not reach any outcome; in contrast, 11 (23%) in the medium group and 5 (33%) in the high group reached the uncensored composite outcome; 6 (13%) in the medium group and 2 (13%) in the high group had GF; and 8 (17%) in the medium group and 4 (26.7%) in the high group reached the death-censored composite outcomes. In a fully adjusted model, each pretransplant C-peptide unit was not associated with an increased risk of the composite outcome, GF, or death-censored composite outcomes. However, in multivariate analysis with limited adjustment, pretransplant C-peptide was associated with the composite outcome (hazard ratio: 1.18, 95% confidence interval, 1.01-1.38; P = 0.03) and death-censored composite outcome (hazard ratio: 1.20; 95% confidence interval, 1.01-1.42; P = 0.03). CONCLUSIONS Although limited by the small sample size, we found excellent outcomes among T2DM SPK recipients overall. However, higher levels of pretransplant C-peptide may be associated with inferior posttransplant outcomes that include graft dysfunction.
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4
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Rössler F, Kümmerli C, Hügli S, Jonas JP, Hübel K, Oberkofler CE, Müller PC, de Rougemont O. Effect of donor pancreas extraction time on pancreas transplantation-a Swiss tertiary center experience. Clin Transplant 2023; 37:e14846. [PMID: 36322914 DOI: 10.1111/ctr.14846] [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: 10/09/2022] [Revised: 10/24/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022]
Abstract
We aimed to assess the effect of donor pancreas extraction time (ET) on postoperative complications and graft function after pancreas transplantation (PT). We analyzed all consecutive donor pancreas procurements for the simultaneous pancreas and kidney transplantation (SPK) and the associated PT in a Swiss transplant center over a 20-year period. Pancreas ET was defined as the time from cold flush to static storage of the pancreas on ice. The primary endpoint was the effect of extraction time on surgical complications. Secondary endpoints comprised the effect of ET on graft function (insulin-free survival) and graft pancreatitis. Of 115 procured pancreas grafts the median donor pancreas ET was 65 min (IQR: 48-78 min). In multivariable analysis, ET did not negatively affect major complications (OR 1.41 [95% CI: .59-3.36]; p = .438) and insulin-free survival (HR 1.42 [95% CI: .55-3.63]; p = .459). The median CIT was 522 (441-608) min. CIT was associated with major complications (OR 2.51 [95% CI: 1.11-5.68]; p = .027), but without impact on insulin-free survival (HR 1.94 [95% CI: .84-4.48]; p = .119). Patients with and without graft pancreatitis had no statistically significant differences in ET and CIT (p = .164 and p = .47, respectively). In multivariable analysis, Amylase levels > 270 U/L on postoperative day 1 were significantly associated with major complications (OR 3.61 [95% CI: 1.06-12.32]; p = .040). Our results suggest that although no effect of ET on complications and graft function after PT was found, shorter CIT and less graft pancreatitis can have a positive impact on surgical complications. Results could possibly be influenced by the exceptional quality of the pancreas donors, with short travel distances and preservation times in Switzerland.
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Affiliation(s)
- Fabian Rössler
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Kümmerli
- Clarunis, University Centre for Gastrointestinal and Liver Diseases, University Hospital Basel, Basel, Switzerland
| | - Sandro Hügli
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Jan P Jonas
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Kerstin Hübel
- Department of Nephrology, University Hospital Zurich, Zurich, Switzerland
| | - Christian E Oberkofler
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland.,Vivèvis AG - Visceral, Tumor And Robotic Surgery Clinic Hirslanden Zürich, Zürich, Switzerland
| | - Philip C Müller
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
| | - Olivier de Rougemont
- Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland
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5
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Parajuli S, Djamali A, Mandelbrot D, Aziz F, Radke N, Kaufman D, Odorico J. The Presence of Donor-specific Antibodies Around the Time of Pancreas Graft Biopsy With Rejection Is Associated With an Increased Risk of Graft Failure. Transplantation 2022; 106:e289-e296. [PMID: 35427295 DOI: 10.1097/tp.0000000000004133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Donor-specific antibodies (DSA) against HLA are an important biomarker predicting graft injury, rejection (Rej), and failure in various solid-organ transplant recipients. However, the impact of DSA with or without histopathological evidence of rejection among pancreas transplant recipients (PTRs) is unknown. METHODS In this study, we included all PTRs at our center between 2005 and 2020, with pancreas allograft biopsy before March 31, 2021, and with DSA checked within 15 d of the biopsy. PTRs were divided into 4 groups based on the biopsy findings on the index biopsy and DSA status as Rej-/DSA-, Rej+/DSA-, Rej-/DSA+, and Rej+/DSA+. RESULTS Two hundred two PTRs had a pancreas allograft biopsy during the study period. Thirty-nine were in Rej-/DSA-, 84 Rej+/DSA-, 24 Rej-/DSA+, and 55 Rej+/DSA+. The mean interval from transplant to index biopsy was not statistically different between the 4 groups. The most common type of rejection was T cell-mediated rejection; however, antibody-mediated rejection was more prevalent in the Rej+/DSA+ group. At 5 y postbiopsy, the rate of death-censored graft failure (DCGF) for Rej-/DSA- was 18%, 24% in Rej+/DSA-; 17% in Rej-/DSA+ and 36% in Rej+/DSA+ (P = 0.14). In univariate analysis, mixed rejection (hazard ratio [HR], 3.0; 95% confidence intervals [CI], 1.22-7.39; P = 0.02) along with solitary pancreas transplantation and Rej+/DSA+ were associated with DCGF. In multivariate analysis, compared with Rej-/DSA-, Rej+/DSA+ was significantly associated with DCGF (HR, 2.32; 95% CI, 1.03-5.20; P = 0.04); however, Rej+/DSA- was not (HR, 1.06; 95% CI, 0.32-3.56; P = 0.92). CONCLUSIONS PTRs with pancreas allograft rejection and concomitant DSA have an increased risk of DCGF.
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Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- 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
| | - Fahad Aziz
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nancy Radke
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Dixon Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jon Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI
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6
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Hemostasis caused by stent-graft insertion followed by graft removal for pancreas graft bleeding due to chronic rejection: A case report. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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7
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Inferior survival outcomes of pancreas transplant alone in uremic patients. Sci Rep 2021; 11:21073. [PMID: 34702876 PMCID: PMC8548435 DOI: 10.1038/s41598-021-00621-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/14/2021] [Indexed: 11/09/2022] Open
Abstract
Theoretically, pancreas transplant alone in uremic (PTAU) patients could also be one of the options for those waiting for both pancreas and kidney grafts, but it has never been reported. There were 160 cases of pancreas transplant in this study, including 16% PTAU. The 5-year patient survival was 66.2% after PTAU, 94.5% after SPK, 95.8% after PAK, and 95.4% after PTA. Rejection of pancreas graft was significantly lower in PTAU group (3.8%), followed by 16.7% in pancreas after kidney transplant (PAK), 29.8% in simultaneous pancreas and kidney transplant (SPK) and 37.0% in pancreas transplant alone (PTA). Fasting blood sugar and serum HbA1c levels after PTAU were not significantly different from those by other subgroups. The 5-year death-censored pancreas graft survival was 100% after PTAU and PAK, and 97.0% after SPK and 77.9% after PTA. However, the 5-year death-uncensored pancreas graft survival was 67.0% after PTAU, 100% after PAK, 91.3% after SPK, and 74.0% after PTA. The superior graft survival in the PTAU group was achieved only if deaths with a functioning graft were censored. In conclusion, given the inferior patient survival outcome, PTAU is still not recommended unless SPK and PAK is not available. Although PTAU could be a treatment option for patients with diabetes complicated by end-stage renal disease (ESRD) in terms of surgical risks, endocrine function, and immunological and graft survival outcomes, modification of the organ allocation policies to prioritize SPK transplant in eligible patients should be the prime goal.
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8
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Parajuli S, Kaufman DB, Djamali A, Welch BM, Sollinger HW, Mandelbrot DA, Odorico JS. Association of human leukocyte antigen mismatches between donor-recipient and donor-donor in pancreas after kidney transplant recipients. Transpl Int 2021; 34:2803-2815. [PMID: 34644422 DOI: 10.1111/tri.14138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
The effects of HLA mismatching on pancreas outcomes among pancreas after kidney (PAK) recipients are undefined. Outcomes might potentially differ depending on whether there is a mismatch between pancreas donor and recipient (PD-R) or pancreas donor and kidney donor(PD-KD). All primary PAK at our centre were included in this study. Patients were divided into two groups based on the degree of HLA mismatching: low (L-MM) as 0-4 and high (H-MM) as 5-6. We analysed all (N = 73) PAK for PD-R mismatch and the subset of PAK for PD-KD mismatch (N = 71). Comparing PD-R L-MM (n = 39) and H-MM (n = 34) PAKs, we observed no difference in the rate of pancreas graft failure. There was also no difference in the rate of rejection (L-MM 33% vs. H-MM 41%) or the severity of rejection. However, we observed a significantly (P < 0.01) shorter time to acute pancreas rejection in the H-MM group (6.8 ± 8.7 mo) versus the L-MM cohort (29.0 ± 36.2 mo) (P < 0.001). Similar to the PD-R mismatched cohort, we did not observe a detrimental effect of HLA mismatching on graft outcomes in the PD-KD cohort; time to rejection was again shorter in the H-MM subset. In this study, we found no impact of HLA mismatch on either pancreas graft survival or rejection rates, though rejection occurred earlier in high mismatched PAK transplants.
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Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Dixon B Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Arjang Djamali
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Bridget M Welch
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hans W Sollinger
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jon S Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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9
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Kukla A, Ventura-Aguiar P, Cooper M, de Koning EJP, Goodman DJ, Johnson PR, Han DJ, Mandelbrot DA, Pavlakis M, Saudek F, Vantyghem MC, Augustine T, Rickels MR. Transplant Options for Patients With Diabetes and Advanced Kidney Disease: A Review. Am J Kidney Dis 2021; 78:418-428. [PMID: 33992729 DOI: 10.1053/j.ajkd.2021.02.339] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/21/2021] [Indexed: 02/06/2023]
Abstract
Optimal glycemic control in kidney transplant recipients with diabetes is associated with improved morbidity and better patient and allograft survival. Transplant options for patients with diabetes requiring insulin therapy and chronic kidney disease who are suitable candidates for kidney transplantation should include consideration of β-cell replacement therapy: pancreas or islet transplantation. International variation related to national regulatory policies exists in offering one or both options to suitable candidates and is further affected by pancreas/islet allocation policies and transplant waiting list dynamics. The selection of appropriate candidates depends on patient age, coexistent morbidities, the timing of referral to the transplant center (predialysis versus on dialysis) and availability of living kidney donors. Therefore, early referral (estimated glomerular filtration rate < 30 mL/min/1.73 m2) is of the utmost importance to ensure adequate time for informed decision making and thorough pretransplant evaluation. Obesity, cardiovascular disease, peripheral vascular disease, smoking, and frailty are some of the conditions that need to be addressed before acceptance on the transplant list, and ideally before dialysis becoming imminent. This review offers insights into selection of pancreas/islet transplant candidates by transplant centers and an update on posttransplant outcomes, which may have practice implications for referring nephrologists.
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Affiliation(s)
- Aleksandra Kukla
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | | | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - David J Goodman
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Paul R Johnson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Duck J Han
- Division of Transplantation, Department of Surgery, Asan Medical Center, Seoul, South Korea
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, WI
| | - Martha Pavlakis
- Division of Nephrology, Department of Medicine, Beth Isreal Deaconess Medical Center, Boston, MA
| | - Frantisek Saudek
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marie-Christine Vantyghem
- CHU Lille, Department of Endocrinology, Diabetology and Metabolism, Inserm U1190, Translational Research for Diabetes, Univ Lille, European Genomic Institute for Diabetes, Lille, France
| | - Titus Augustine
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology Medicine and Health, Manchester Academic Health Centre, University of Manchester, Manchester, United Kingdom.
| | - Michael R Rickels
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
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10
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Parajuli S, Mandelbrot DA. One more time, emphasizing the advantage of simultaneous pancreas and kidney transplantation for patients with type 1 diabetes and end‐stage renal disease. Transpl Int 2020; 33:1384-1386. [PMID: 32620051 DOI: 10.1111/tri.13686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/25/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Didier A. Mandelbrot
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
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11
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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.
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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
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Parajuli S, Swanson KJ, Patel R, Astor BC, Aziz F, Garg N, Mohamed M, Al‐Qaoud T, Redfield R, Djamali A, Kaufman D, Odorico J, Mandelbrot DA. Outcomes of simultaneous pancreas and kidney transplants based on preemptive transplant compared to those who were on dialysis before transplant – a retrospective study. Transpl Int 2020; 33:1106-1115. [PMID: 32479673 DOI: 10.1111/tri.13665] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 04/14/2020] [Accepted: 05/22/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Sandesh Parajuli
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Kurtis J. Swanson
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Ravi Patel
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Brad C. Astor
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
- Department of Population Health Sciences University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Fahad Aziz
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Neetika Garg
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Maha Mohamed
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Talal Al‐Qaoud
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Robert Redfield
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Arjang Djamali
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Dixon Kaufman
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Jon Odorico
- Division of Transplant Surgery University of Wisconsin School of Medicine and Public Health Madison WI USA
| | - Didier A. Mandelbrot
- Division of Nephrology Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
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