Multivariate Analysis of Risk Factors for Early Loss of Pancreas Grafts Among Simultaneous Pancreas–Kidney Transplants

Sousa, Marcelo Gonçalves; Linhares, Marcelo Moura; Gonzalez, A.M.; Rangel, Érika B.; Melaragno, Cláudio S.; Sá, João Roberto de; Salzedas, Alcides; Nishimi, Alexandre Yukio; Filho, Gaspar Jesus Lopes; Matos, Délcio; Pestana, José Osmar Medina

doi:10.1016/j.transproceed.2010.01.044

Cited by 14 publications

(4 citation statements)

References 18 publications

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“…We found that at 20 h of CIT, there was a trend toward decreased graft survival but this did not reach statistical significance. Other groups have also reported little impact of moderate prolongation of CIT on graft or patient survival (15,16). The use of fixed wing charter flights to transplant imported pancreata significantly reduces cold ischemia time but increases overall cost (17).…”

Section: Discussionmentioning

confidence: 99%

Comparison of Recipient Outcomes Following Transplant From Local Versus Imported Pancreas Donors

Finger

Radosevich

Bland

et al. 2012

American Journal of Transplantation

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The shortage of deceased donor organs for solid organ transplantation continues to be an ongoing dilemma. One approach to increase the number of pancreas transplants is to share organs between procurement regions. To assess for the effects of organ importation, we reviewed the outcomes of 1014 patients undergoing deceased donor pancreas transplant at a single center. We performed univariate and multivariate analyses of the association of donor, recipient and surgical characteristics with patient outcomes. Organ importation had no effect on graft or recipient survival for recipients of solitary pancreas transplants. Similarly, there was no effect on technical failure rate, graft survival or long-term patient survival for simultaneous kidneypancreas (SPK) recipients. In contrast, there was a significant and independent increased risk of death in the first year in SPK recipients of imported organs. SPK recipients had longer hospitalizations and increased hospital costs. This increased medical complexity may make these patients more susceptible to short-term complications resulting from the longer preservation times of import transplants. These findings support the continued use of organ sharing to reduce transplant wait times but highlight the importance of strategies to reduce organ preservation times.

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Section: Discussionmentioning

confidence: 99%

Comparison of Recipient Outcomes Following Transplant From Local Versus Imported Pancreas Donors

Finger

Radosevich

Bland

et al. 2012

American Journal of Transplantation

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“…Some studies have suggested that it is a strong independent risk factor for graft loss 12 and thrombosis, 13 whereas others have shown it may only be a factor indirectly, that is, a surrogate for other factors including a "cause of death other than trauma." 14 Either way, it would be prudent to consider limiting donors of advanced age, especially when the same patients have other risk factors, which in conjunction with their age, would almost certainly increase the incidence of thrombosis and reduce overall graft survival.…”

Section: Introductionmentioning

confidence: 99%

Prevention and Management of Graft Thrombosis in Pancreatic Transplant

Patel¹,

Hakim²

2012

Exp Clin Transplant

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Pancreatic transplant effectively cures type 1 diabetes mellitus and maintains consistent longterm euglycemia. However, technical failure, and in particular graft thrombosis, accounts for the vast majority of transplants lost in the early postoperative period. The pancreas' inherently low microvascular flow state makes it vulnerable to vascular complications, as does the hypercoagulable blood of diabetic patients. Ultimately, the phenomenon is most definitely multifactorial. Prevention, as opposed to treatment, is key and should focus on reducing these multiple risk factors. This will involve tactical donor selection, optimal surgical technique and some form of anticoagulation. Close monitoring and early intervention will be crucial when treating thrombosis once preventative methods have failed. This may be achieved by further anticoagulation, graft salvage, or pancreatectomy with retransplant. This article will explore the multiple factors contributing to graft thrombus formation and the ways in which they may be addressed to firstly prevent, or more likely, reduce thrombosis. Secondly, we will consider the management strategies which can be implemented once thrombosis has occurred.

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“…The majority of postoperative complications that require surgical treatment in the SPKT population are pancreas-related (8,18,19), which is consistent with our findings, as 28.2% of our patients suffered from a kidney-related major complication, whilst the rate was 43.6% for pancreas-related. Some donor, recipient and transplant characteristics, such as donor age, cold ischaemia time and time on dialysis treatment have demonstrated an influence on the incidence of surgical complications (18,(20)(21)(22). Patient selection becomes essential to decrease complications rates.…”

confidence: 99%

Simultaneous pancreas-kidney transplantation: Early complications and long-term outcomes – a single-centre experience

Crespo

Cubillana

González

et al. 2022

CUAJ

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Introduction: This study aimed to assess the prevalence and severity of complications after simultaneous pancreas-kidney transplantation (SPKT) and to evaluate its influence on both grafts’ long-term results. Methods: This was an observational, retrospective study including 39 consecutive SPKT cases from 2000–2018. Complications were classified into kidney-related and pancreas-related. The severity of complications was assessed using the modified Clavien-Dindo scale. Kaplan-Meier curve analysis and log-rank tests were used. Cox regression was performed for the multivariate analysis. Results: All 39 recipients had long-term type I diabetes. Twenty-one (53.8%) patients suffered a Clavien-Dindo ≥IIIa complication. Most complications were pancreas-related, with 17 (43.6%) patients suffering from one. Kidney-related major complications were seen in 11 (28.2%) patients. Patient survival at one, five, and 15 years was 89.7%, 87.1%, and 83.9%, respectively; kidney survival was 87.1%, 81.4%, and 73.6%, respectively; and pancreas survival was 76.9%, 71.3%, and 72%, respectively. Pancreas graft survival was influenced by the presence of major postoperative complications; patients and kidney graft survival were not. Conclusions: Complications after SPKT influence pancreas graft survival. Despite the high rate of complications, our results suggest that patients' and kidney graft survival may not be affected by complications.

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Multivariate Analysis of Risk Factors for Early Loss of Pancreas Grafts Among Simultaneous Pancreas–Kidney Transplants

Cited by 14 publications

References 18 publications

Comparison of Recipient Outcomes Following Transplant From Local Versus Imported Pancreas Donors

Comparison of Recipient Outcomes Following Transplant From Local Versus Imported Pancreas Donors

Prevention and Management of Graft Thrombosis in Pancreatic Transplant

Simultaneous pancreas-kidney transplantation: Early complications and long-term outcomes – a single-centre experience

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