Introduction
Only 3.4% of simultaneous pancreas and kidney transplants (SPKT) in the UK are performed for recipients with T2DM. The aim of this study was to compare outcomes after SPKT for recipients with either T1DM or T2DM.
Methods
Data on all UK SPKTs from 2003–2019 were obtained from the NHSBT UK Transplant Registry (n=2,236). Current SPKT selection criteria for T2DM requires insulin treatment and recipient BMI<30kg/m2 at listing. Cases where the aetiology of diabetes was missing and recipients who had received a re-transplant were excluded, resulting in a final cohort of n=2,154. Graft (GS) and patient (PS) survival analyses were conducted using Kaplan-Meier plots and Cox regression models. Complications were compared using chi-squared analyses.
Results
The majority of SPKTs were performed in recipients with T1DM (95.6%, n=2,060), and 3.4% (n=94) were performed in T2DM recipients. Recipients with T2DM were statistically significantly more likely to be older (p<0.0001), male (p<0.0001), with a higher BMI (p=0.0191), and not requiring dialysis (p<0.0001). Univariate analysis showed comparable outcomes for GS and PS at 1yr (GS p=0.120; PS p=0.886) and 3yrs (GS p=0.316; PS p=0.237). Multi-variate analysis also showed comparable outcomes in GS (p=0.564, HR 1.221, 95%CI 0.619, 2.406) and PS (p=0.556, HR 1.280, 95%CI 0.563, 2.911). Common complications after SPKT were analysed and no statistically significant differences were seen between recipients.
Conclusion
This is the largest European study evaluating outcomes after SPKT comparing recipients with T1DM or T2DM. Carefully selected recipients with T2DM were shown to have comparable graft survival, patient survival and rates of complications.
Take-home message
Carefully selected recipients with T2DM were shown to have comparable graft survival, patient survival and rates of complications.
Introduction
The post-operative care (POC) of paediatric patients undergoing spinal surgery is essential. Initial audits (2015/17) identified shortcomings in POC practice.
Aim
To evaluate improvements in compliance with local AIS guidelines following application of a simple POC checklist. To identify reasons where standards are not met with formulation of an action plan to ensure the AIS POC pathway continues to improve and provide optimum levels of care for our patients.
Method
Data was collected retrospectively for 30 patients over 2 years. Standards assessed were taken from local AIS guidelines consisting of 25 distinct domains (Appendix 1).
Results
Our post-intervention results showed that, 100% compliance within individual AIS guideline domains improved significantly from 12/25 domains (2015), to 21/25 (2019/20). In the domains that did not meet 100% compliance, post-intervention, 2 reached 93.33% compliance and 2 reached 80% (2019/20), a significant improvement upon 2015/17 where several domains were within 20-70% compliance.
Conclusions
The results demonstrate that our intervention, a simple checklist, significantly improved the POC of our AIS patients and current practice is of an excellent standard. Standards were still not met in 2020 for a handful of measures. This was due to patients declining planned antiemetic/analgesic medication or rarely, incomplete documentation by health care professionals who were not yet fully familiar with the new checklist. Other centres offering surgical intervention for AIS may benefit from adopting/adapting this POC checklist and a similar audit may prove useful to optimise care for these paediatric patients undergoing significant surgery.
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