Simultaneous pancreas and kidney transplantation: Incidence and risk factors for amputation after 10‐year follow‐up

MacCraith, Eoin; Davis, Niall F.; Browne, Cliodhna; Mohan, Ponnusamy; Hickey, David P.

doi:10.1111/ctr.12976

Cited by 8 publications

(11 citation statements)

References 18 publications

(26 reference statements)

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“…Morissey et al found that despite excellent transplant outcomes and lower risk factors for PAD, SPKT recipients had a greater incidence of PAD related complications more than 4 years after transplantation [9]. Recent long-term data by MacCraith et al indicate that also after a 10 year follow up, patients are at significant greater risk of amputation after SPKT compared to KTA [10]. Increased risks of PAD in SPKT recipients might in part depend on the technique of pancreas transplantation.…”

Section: Discussionmentioning

confidence: 99%

“…On one hand several studies report a significant higher incidence of PVD and worse vascular outcomes in patients with a SPKT when compared to those receiving a kidney transplant alone (KTA) [9]. A recent long-term study on incidence and risk factors in SPKT patients also reported a higher incidence of amputation after SPKT (up to 8.64%) when compared to KTA [10].…”

Section: Introductionmentioning

confidence: 99%

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Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases

et al. 2019

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BackgroundThe effects of Simultaneous Pancreas Kidney Transplantation (SPKT) on Peripheral Vascular Disease (PVD) warrants additional study and more target focus, since little is known about the mid- and long-term effects on the progression of PVD after transplantation.Methods101 SPKT and 26 Kidney Transplantation Alone (KTA) recipients with insulin-dependent diabetes mellitus (IDDM) were retrospectively evaluated with regard to graft and metabolic outcome. Special subgroup analysis was directed towards the development and progression of peripheral vascular complications (PVC) (amputation, ischemic ulceration, lower extremity angioplasty/ bypass surgery) after transplantation.ResultsThe 10-year patient survival was significantly higher in the SPKT group (SPKT: 82% versus KTA 40%; P < 0.001). KTA recipients had a higher prevalence of atherosclerotic risk factors, including coronary artery disease (P < 0.001), higher serum triglyceride levels (P = 0.049), higher systolic (P = 0.03) and diastolic (P = 0.02) blood pressure levels. The incidence of PVD before transplantation was comparable between both groups (P = 0.114). Risk factor adjusted multivariate analysis revealed that patients with SPKT had a significant lower amount (32%) of PVCs (32 PVCs in 21 out of 101 SPKT; P < 0.001) when compared to the KTA patients who developed a significant increase in PVCs to 69% of cases (18 PVCs in 11 out of 26 KTA; P < 0.001). In line mean values of HbA1c (P < 0.01) and serum triglycerides (P < 0.01) were significantly lower in patients with SPKT > 8 years after transplantation.ConclusionSPKT favorably slows down development and progression of PVD by maintaining a superior metabolic vascular risk profile in patients with IDDM1.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases

et al. 2019

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“…Simultaneous pancreas‐kidney (SPK) transplantation is currently the gold standard treatment of type 1 insulin‐dependent diabetes mellitus (DM) and corresponding end‐stage renal disease (ESRD) 1 . In addition to pancreatic insufficiency and ESRD, patients with type 1 DM are also at high risk of lower extremity (LE) peripheral artery disease (PAD), both before and after transplant 1 . The development of PAD is a significant source of morbidity for SPK recipients 1‐4 .…”

Section: Introductionmentioning

confidence: 99%

“…In addition to pancreatic insufficiency and ESRD, patients with type 1 DM are also at high risk of lower extremity (LE) peripheral artery disease (PAD), both before and after transplant 1 . The development of PAD is a significant source of morbidity for SPK recipients 1‐4 . One of the earliest studies examining this phenomenon was published in 2003; in a cohort of 200 SPK recipients with type 1 DM, the authors reported an amputation incidence of 6.5% prior to SPK compared with 9.5% after SPK and identified pre‐transplant amputation and duration of dialysis as significant risk factors associated with post‐transplant amputation 4 …”

Section: Introductionmentioning

confidence: 99%

Long‐term Lower Extremity and Cardiovascular Complications after Simultaneous Pancreas‐Kidney Transplant

Amara

Braun

Shui

et al. 2021

Clinical Transplantation

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Lower extremity (LE) vascular disease and adverse cardiovascular events (ACEs) cause significant long‐term morbidity after simultaneous pancreas‐kidney (SPK) transplantation. This study's purpose was to describe the incidence of, and risk factors associated with, LE vascular complications and related ACEs following SPK. All SPKs performed at the authors’ institution from 2000 to 2019 were retrospectively analyzed. The primary outcome was any LE vascular event, defined as LE endovascular intervention, open surgery, amputation, or invasive podiatry intervention. Secondary outcomes included post‐SPK ACE. A total of 363 patients were included, of whom 54 (14.9%) required at least one LE vascular intervention following SPK. Only 3 patients received pre‐SPK ankle brachial indices (ABIs). A history of peripheral artery disease (PAD) (HR 2.95, CI 1.4‐6.2) was a risk factor for post‐SPK LE vascular intervention even after adjustment for other factors. Fifty‐nine (16.3%) patients experienced an ACE in follow‐up. Requiring a LE intervention post‐SPK was associated with a subsequent ACE (HR 2.3, CI 1.2‐4.5). LE vascular and cardiovascular complications continue to be significant sources of morbidity for SPK patients, especially for patients with preexisting PAD. The highest risk patients may benefit from more intensive pre‐ and post‐SPK workup with ABIs and follow‐up with a vascular surgeon.

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“…Technical failure in pancreatic transplantation is described as graft loss due to vascular thrombosis, pancreatitis, intra-abdominal infections, anastomotic leaks or bleeding [ 7 ]. Furthermore, multiple studies have shown that vascular thrombosis is the major cause of pancreatic graft failure and is responsible for more than half of all losses within the first 3 months after transplant [ [8] , [9] ].…”

Section: Introductionmentioning

confidence: 99%

The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation

Shahbazov

Azari

Whan

et al. 2018

International Journal of Surgery Case Reports

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Simultaneous pancreas and kidney transplantation: Incidence and risk factors for amputation after 10‐year follow‐up

Abstract: The incidence of amputation after SPK transplantation is approximately 9% after 10-year follow-up. Patients are at a significantly greater risk of amputation after SPK transplantation compared to KTA for type 1 diabetes despite insulin independence.

Cited by 8 publications

References 18 publications

Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases

Effects of simultaneous pancreas-kidney transplantation and kidney transplantation alone on the outcome of peripheral vascular diseases

Long‐term Lower Extremity and Cardiovascular Complications after Simultaneous Pancreas‐Kidney Transplant

The successful salvage of a thrombosed pancreatic graft at the early postoperative period of a simultaneous pancreas and kidney transplantation

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