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Ventura-Aguiar P, Cabello M, Beneyto I, Navarro Cabello D, Tabernero G, Alonso A, Ruiz JC, Llorente S. Patient and graft survival in pancreas transplant recipients: The EFISPAN study. Nefrologia 2023; 43:133-143. [PMID: 36494288 DOI: 10.1016/j.nefroe.2022.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 09/15/2021] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION AND OBJECTIVES Graft outcomes in pancreas transplantation have improved in recent decades, but data are mainly derived from registries or prospective single-centre studies. This large epidemiological study was undertaken to investigate the impact of clinical and demographic factors on graft and patient survival in pancreas transplant recipients in Spain, and to provide robust, country-wide, practice-based data to complement registry findings. PATIENTS AND METHODS We conducted a retrospective, longitudinal, epidemiological study to assess risk factors impacting patient and graft survival in pancreas transplant recipients in eight centres in Spain. All patients transplanted between 1 January 2008 and 31 December 2012 were included; data were collected until 31 December 2015. The Kaplan-Meier method was used for all time-to-event analyses, including patient survival, graft survival, acute rejection, and BPAR. For graft survival analysis, in cases of death with functioning graft, patients were censored without any event on the date of death. For acute rejection and BPAR, patients were censored without any event on the date of death or graft loss. Univariable and multivariable analyses (Cox proportional hazards model) were conducted to assess the association between baseline clinical and demographic characteristics and patient/graft survival. RESULTS Data were included for 241 (80.1%) simultaneous pancreas-kidney transplants, 56 (18.6%) pancreas-after-kidney transplants and 4 (1.3%) pancreas transplants alone. Mean±standard deviation time from diagnosis until transplantation was 26.1±7.5 years. Nineteen patients died, mainly due to infections (n=10); the remaining 282 patients (93.7%) survived from transplantation until the end of the study. Among 55 patients (18.3%) with pancreas graft loss, the main reasons were vascular thrombosis (n=19), chronic rejection (n=10), acute rejection (n=6) and death with a functioning graft (n=5). The overall rate of vascular-related death was 1.3% at 5 years post transplant. Univariable analysis showed that patient age and weight, donor age, previous kidney transplantation, previous cardiovascular events and need for insulin more than 48h post transplantation were significantly associated with pancreas graft survival. Of these, in multivariable analyses pancreas graft survival was inferior in patients who had received a previous kidney transplant prior to pancreas transplantation (log-rank test, p=0.0002). Glucose metabolism, renal function and cardiovascular risk factors were generally stable following transplantation. CONCLUSIONS The results of this multicentre study highlight the excellent patient and graft outcomes following pancreas transplantation, with a notably low incidence of cardiovascular events.
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Affiliation(s)
- Pedro Ventura-Aguiar
- Department of Nephrology and Kidney Transplantation, Hospital Clinic, Barcelona, Spain.
| | - Mercedes Cabello
- Department of Nephrology, Hospital Regional Universitario de Malaga, Málaga, Spain
| | - Isabel Beneyto
- Department of Nephrology, Hospital La Fe, Valencia, Spain
| | | | - Guadalupe Tabernero
- Department of Nephrology, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Angel Alonso
- Department of Nephrology, Hospital Universitario de A Coruña, A Coruña, Spain
| | - Juan Carlos Ruiz
- Department of Nephrology, Hospital Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain
| | - Santiago Llorente
- Department of Nephrology, Hospital Virgen de la Arrixaca, Murcia, Spain
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Muñoz-Bellvis L, Esteban MDC, Iglesias M, González L, González-Muñoz JI, Muñoz-González C, E Quiñones J, Tabernero G, Iglesias RA, Sayagués JM, Fraile P. Development and results of a novel pancreas transplant program in Spain: the surgeon's point of view. Cir Esp 2018; 96:205-12. [PMID: 29501238 DOI: 10.1016/j.ciresp.2017.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [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.
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Jiménez-Romero C, Marcacuzco Quinto A, Manrique Municio A, Justo Alonso I, Calvo Pulido J, Cambra Molero F, Caso Maestro Ó, García-Sesma Á, Moreno González E. Simultaneous pancreas-kidney transplantation. Experience of the Doce de Octubre Hospital. Cir Esp 2017; 96:25-34. [PMID: 29089105 DOI: 10.1016/j.ciresp.2017.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Simultaneous pancreas-kidney transplantation (SPKT) constitutes the therapy of choice for diabetes type1 or type2 associated with end-stage renal disease, because is the only proven method to restore normo-glicemic control in the diabetic patient. METHODS Retrospective and descriptive study of a series of 175 patients who underwent SPKT from March 1995 to April 2016. We analyze donor and recipient characteristics, perioperative variables and immunosuppression, post-transplant morbi-mortality, patient and graft survival, and risk factors related with patient and graft survival. RESULTS Median age of the donors was 28years and mean age of recipients was 38.8±7.3years, being 103 males and 72 females. Enteric drainage of the exocrine pancreas was performed in 113 patients and bladder drainage in 62. Regarding post-transplant complications, the overall rate of infections was 70.3%; graft pancreatitis 26.3%; intraabdominal bleeding 17.7%; graft thrombosis 12.6%; and overall pancreas graft rejection 10.9%. The causes of mortality were mainly cardiovascular and infectious complications. Patient survival at 1, 3 and 5-year were 95.4%, 93% and 92.4%, respectively, and pancreas graft survival at 1, 3 and 5-year were 81.6%, 77.9% y 72.3%, respectively. CONCLUSIONS In our 20-year experience of simultaneous pancreas-kidney transplantation, the morbidity rate, and 5-year patient and pancreas graft survivals were similar to those previously reported from the international pancreas transplant registries.
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Affiliation(s)
- Carlos Jiménez-Romero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - Alberto Marcacuzco Quinto
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Alejandro Manrique Municio
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Iago Justo Alonso
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Jorge Calvo Pulido
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Félix Cambra Molero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Óscar Caso Maestro
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Álvaro García-Sesma
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Enrique Moreno González
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Abstract
In December 1966, the first pancreas transplant ever was performed at the University of Minnesota. R. Lillehei and W. Kelly, transplanted a kidney and a pancreas in a diabetic patient on dialysis, getting function of both organs. Since then, the technical and immunological advances in this transplant have resulted in graft and patient survival results as the rest of the abdominal solid organ transplants. The balance of these 50 years is that more than 50,000 diabetic patients have been transplanted in more than 200 centers around the world. In our country the first transplant was performed 34 years ago in Barcelona and now 12 centers perform about 100 transplants per year. Although advances in diabetes control have been very important, pancreas transplantation continues to be the only method that allows normalization of the carbohydrates metabolism to improve the quality of life and, above all, to increase the survival of these patients.
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Affiliation(s)
- Daniel Casanova
- Chairman Board Europeo de Trasplante, Servicio de Cirugía General y Digestiva Hospital Universitario Marqués de Valdecilla, Santander, España.
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- Chairman Board Europeo de Trasplante, Servicio de Cirugía General y Digestiva Hospital Universitario Marqués de Valdecilla, Santander, España
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Moya-Herraiz A, Muñoz-Bellvis L, Ferrer-Fábrega J, Manrique Municio A, Pérez-Daga JA, Muñoz-Casares C, Alarcó-Hernández A, Gómez-Gutiérrez M, Casanova-Rituerto D, Sanchez-Bueno F, Jimenez-Romero C, Fernández-Cruz Pérez L. Cooperative Study of the Spanish Pancreas Transplant Group (GETP): Surgical Complications. Cir Esp 2015; 93:300-6. [PMID: 25638511 DOI: 10.1016/j.ciresp.2014.12.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 12/16/2014] [Indexed: 12/11/2022]
Abstract
UNLABELLED Technical failure in pancreas transplant has been the main cause of the loss of grafts. In the last few years, the number of complications has reduced, and therefore the proportion of this problem. OBJECTIVES The Spanish Pancreas Transplant Group wanted to analyze the current situation with regard to surgical complications and their severity. MATERIAL AND METHODS A retrospective and multicenter study was performed. 10 centers participated, with a total of 410 pancreas transplant recipients between January and December 2013. RESULTS A total of 316 transplants were simultaneous with kidney, 66 after kidney, pancreas-only 10, 7 multivisceral and 11 retrasplants. Surgical complication rates were 39% (n=161). A total of 7% vascular thrombosis, 13% bleeding, 6% the graft pancreatitis, 12% surgical infections and others to a lesser extent. Relaparotomy rate was 25%. The severity of complications were of type IIIb (13%), type II (12%) and type IVa (8.5%). Graft loss was 8%. Early mortality was 0.5%. The percentage of operations for late complications was 17%. CONCLUSIONS The number of surgical complications after transplantation is not negligible, affecting one in 3 patients. They are severe in one out of 5 and, in one of every 10 patients graft loss occurs. Therefore, there is still a significant percentage of surgical complications in this type of activity, as shown in our country.
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Affiliation(s)
- Angel Moya-Herraiz
- Unidad de Cirugía HPB y Trasplante, Servicio de Cirugía General, Hospital Universitari y Politècnic La Fe, Valencia, España.
| | | | - Joana Ferrer-Fábrega
- Servicio de Cirugía Hepato-bilio-pancreática y Trasplante, ICMDiM, Hospital Clínic, Barcelona, España
| | | | | | | | | | - Manuel Gómez-Gutiérrez
- Servicio de Cirugía, Programa de Trasplante Hepático y Pancreático, Hospital Juan Canalejo, La Coruña, España; Departamento de Ciencias de la Salud, Universidad de Santiago de Compostela, Santiago de Compostela, España
| | | | - Francisco Sanchez-Bueno
- Departamento de Cirugía, Universidad de Murcia, Murcia, España; Servicio de Cirugía, Hospital Virgen de la Arrixaca, Murcia, España
| | - Carlos Jimenez-Romero
- Servicio de Cirugía General, Aparato Digestivo y Trasplante de Órganos Abdominales, Hospital Doce de Octubre, Madrid, España
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