Early Relaparotomy After Simultaneous Pancreas-Kidney Transplantation

Page, M.; Rimmelé, Thomas; Ber, Charles-Éric; Christin, F.; Badet, Lionel; Morélon, Emmanuel; Écochard, René; Allaouchiche, Bernard

doi:10.1097/tp.0b013e318254dae1

Cited by 40 publications

(48 citation statements)

References 38 publications

(46 reference statements)

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“…The high relaparotomy rate early after transplantation in SPK/PAK transplant recipients was similar to the rate that was reported recently by Page et al (9). In contrast to the overall relaparotomy rate, the number of laparotomies that were caused by complications at the site of the kidney transplantation was not different between groups, indicating that the transplantation of the pancreas was the main reason for an increased complication rate in the wholeorgan transplantation group.…”

Section: Discussionmentioning

confidence: 44%

Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up

Lehmann¹,

Graziano²,

Brockmann

et al. 2015

Diabetes Care

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OBJECTIVEIn patients with type 1 diabetes and end-stage renal disease, combined transplantation of a kidney together with a pancreas or isolated pancreatic islets are options to improve glycemic control. The aim of this study was to compare their long-term outcome with regard to metabolic control and surgical complication rate, as well as function of the transplanted kidney. RESEARCH DESIGN AND METHODSWe conducted a prospective cohort study in consecutive patients receiving either a pancreas or islet transplant simultaneously with or after kidney transplantation (simultaneous pancreas-kidney [SPK]/pancreas-after-kidney [PAK] or simultaneous islet-kidney [SIK]/islet-after-kidney [IAK] transplantation). RESULTSNinety-four patients who had undergone SPK/PAK transplantation were compared with 38 patients who had undergone SIK/IAK transplantation over a period of up to 13 years. HbA 1c levels declined from 7.8 6 1.3% (62 6 14 mmol/mol) to 5.9 6 1.1% (41 6 12 mmol/mol), and from 8.0 6 1.3% (64 6 14 mmol/mol) to 6.5 6 1.1% (48 6 12 mmol/mol), respectively, in the SPK/PAK and SIK/IAK groups (P < 0.001 for both) and remained stable during follow-up, despite a reduction in the rate of severe hypoglycemia by >90%. The 5-year insulin independence rate was higher in the SPK/PAK group (73.6 vs. 9.3% in the SIK/IAK group), as was the rate of relaparotomy after transplantation (41.5 vs. 10.5% in the SIK/IAK group). There was no difference in the rate of kidney function decline. CONCLUSIONSDuring a long-term follow-up, SPK/PAK transplantation as well as SIK/IAK transplantation resulted in a sustained improvement of glycemic control with a slightly higher glycated hemoglobin level in the SIK/IAK group. While insulin independence is more common in whole-organ pancreas recipients, islet transplantation can be conducted with a much lower surgical complication rate and no difference in kidney function decline.

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Section: Discussionmentioning

confidence: 44%

Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up

Lehmann¹,

Graziano²,

Brockmann

et al. 2015

Diabetes Care

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“…Recently the European Association of Urology recommended this grading system to report complications [18]. These studies report re-laparotomy rates ranging from 10% to 65%, most of them related to pancreas graft (up to 60% to 70%) [13,14,19]. Our results included 57 of 139 (41%) re-operations, most of them without graft loss or death (41/57 [72%]).…”

Section: Discussionmentioning

confidence: 61%

“…Most published articles focus on complications that require reoperation but do not use available reporting systems [8,13,14], which will allow series comparison and conclusions to be reached to avoid complications and improve patient care. To address this need, there has been an increase in the number of studies using the ClavienDindo system [15e17].…”

Section: Discussionmentioning

confidence: 98%

Influence of Surgical Complications on Kidney Graft Survival in Recipients of Simultaneous Pancreas Kidney Transplantation

Campos-Hernández

Gómez

Carrasco‐Valiente

et al. 2015

Transplantation Proceedings

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“…The early postoperative period is still considered a high-risk period for a relaparotomy [9]. This suggests that surgical complications are associated with strong non-immunologic complications after transplantation in the early postoperative period [10].…”

Section: Discussionmentioning

confidence: 99%

Outcomes following Simultaneous Pancreas-Kidney Transplantation: Single Center Experience in Korea

Lee¹,

Kim²,

Cho³

et al. 2017

Trends in Transplant

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Purpose: Among organ transplantation, simultaneous pancreas-kidney (SPK) transplantation is becoming increasingly common in patients with type I and II diabetes mellitus (DM). The purpose of this study is to review SPK transplantation cases and learn the lessons from the experience performed at out institution. Methods:We retrospectively reviewed and the analyzed the medical records of 25 SPK transplantation recipients performed from January 2003 to June 2016 in Korea.Results: 25 cases of SPK transplantation were type I DM patients. Twenty-four patients (seven males and 18 females) underwent SPK transplantation from deceased donors, and one female patient received living kidney transplantation. Enteric exocrine drainage via pancreas graft drainage was done in all cases. There were 10 acute rejection cases; all were relieved by steroid pulse therapy. Kidney graft loss occurred in four patients and two pancreatectomy graft surgeries were performed due to one graft necrosis and the other graft rejection. Insulin injection or oral hypoglycemic agents were used for three patients. With the exception of five mortality cases, 20 patients stopped insulin and oral hypoglycemic agents after transplantation. Blood glucose level was maintained within normal range without medication in 16 patients.Conclusion: SPK transplantation is a multiple organ transplantation that requires careful treatment to avoid complications in the postoperative period. SPK transplantation can render insulin dependent type I DM patients with end stage renal disease (ESRD) free from insulin use and produce proper graft functions.

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Early Relaparotomy After Simultaneous Pancreas-Kidney Transplantation

Cited by 40 publications

References 38 publications

Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up

Glycemic Control in Simultaneous Islet-Kidney Versus Pancreas-Kidney Transplantation in Type 1 Diabetes: A Prospective 13-Year Follow-up

Influence of Surgical Complications on Kidney Graft Survival in Recipients of Simultaneous Pancreas Kidney Transplantation

Outcomes following Simultaneous Pancreas-Kidney Transplantation: Single Center Experience in Korea

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