Influence of Intraoperative Hemodynamic Parameters on Outcome in Simultaneous Pancreas–Kidney Transplant Recipients

Abstract

Objectives: Adequate organ perfusion, as well as appropriate blood pressure levels at the time of unclamping, is crucial for early and long-term graft function and outcome in simultaneous pancreas–kidney transplantation (SPKT). However, the optimal intraoperative mean arterial pressure (MAP) level has not well been defined. Methods: From a prospectively collected database, the medical data of 105 patients undergoing SPKT at our center were retrospectively analyzed. A receiver operating characteristic (ROC) analysis was preliminarily performed for optimal cut-off value for MAP at reperfusion, to predict early pancreatic graft function. Due to these results, we divided the patients according to their MAP values at reperfusion into <91 mmHg (n = 47 patients) and >91 mmHg (n = 58 patients) groups. Clinicopathological characteristics and outcomes, as well as early graft function and long-term survival, were retrospectively analyzed. Results: Donor and recipient characteristics were comparable between both groups. Rates of postoperative complications were significantly higher in the <91 mmHg group than those in the >91 mmHg group (vascular thrombosis of the pancreas: 7 (14%) versus 2 (3%); p = 0.03; pancreatitis/intraabdominal abscess: 10 (21%) versus 4 (7%); p = 0.03; renal delayed graft function (DGF): 11 (23%) versus 5 (9%); p = 0.03; postreperfusion urine output: 106 ± 50 mL versus 195 ± 45 mL; p = 0.04). There were no significant differences in intraoperative volume repletion, central venous pressure (CVP), use of vasoactive inotropic agents, and the metabolic outcome. Five-year pancreas graft survival was significantly higher in the >91 mmHg group (>91 mmHg: 82% versus <91 mmHg: 61%; p < 0.01). No significant differences were observed in patient and kidney graft survival at 5 years between both groups. Multivariate Cox regression analysis affirmed MAP < 91 mmHg as an independent prognostic predictor for renal DGF (HR 3.49, 1.1–10.8, p = 0.03) and pancreas allograft failure (HR 2.26, 1.0–4.8, p = 0.01). Conclusions: A MAP > 91 mmHg at the time point of reperfusion was associated with a reduced rate of postoperative complications, enhancing and recovering long-term graft function and outcome and thus increasing long-term survival in SPKT recipients.

Does Timepoint of Surgical Procedure Affect the Outcome in Simultaneous Pancreas–Kidney Transplantation? A Retrospective Single-Center Analysis over 20 Years

“…In our current analysis, we focus on the impact of the timing of surgical procedures on both the immediate and extended outcomes for patients and graft functionality. These particular findings and data have not been previously published [36][37][38][39][40][41][42][43][44].…”

“…The induction phase utilized therapeutic agents such as anti-thymocyte globulin (Thymoglobulin) or the interleukin-2 receptor antagonist basiliximab (Simulect ® ). The ongoing maintenance therapy included a combination of calcineurin inhibitors like Cyclosporin (Sandimmun Neoral ® ) or Tacrolimus (Prograf ® ), possibly in conjunction with antimetabolites such as Sirolimus (Rapamune ® ) or Mycophenolate Mofetil (MMF; Cell Cept ® , Myfortic ® ), and a gradually decreasing dosage of steroids (Prednisolone ® ) [38,39].…”

Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation

“…“Note: This study has partially analysed data of a prospectively collected database with informations of transplant candidates and transplant recipients after pancreas transplantation. In parts, it has been previously published [ 11 , 33 , 34 , 35 , 36 , 37 ]. However, these publications considered different inclusion criterias, answered other specific questions (SPKT for type 1 versus type 2 diabetes mellitus, order of graft implantation, type of dialysis modalities etc.)…”