Simultaneous pancreas-kidney transplantation: infectious complications and microbiological aspects

Linhares, Marcelo Moura; Gonzalez, A.M.; Triviño, Tarcísio; Barbosa, Mauro Marques; Schraibman, Vladimir; Melaragno, Cláudio S.; Moura, Ricardo P.; Silva, M.H.G; Sá, João Roberto de; Aguiar, Wilson; Rangel, Érika B.; Serra, Consol; Succi, T; Pestana, José Osmar Medina

doi:10.1016/j.transproceed.2004.03.114

Cited by 38 publications

(26 citation statements)

References 5 publications

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“…These findings are similar to those of other studies from Poland, namely Milczarczyk et al in which Enterococci were the most common strains isolated from urine [14]. However, our results contrast with the publication of Linhares et al who noted a 44% predominant Gram-negative bacteria [10]. These results also indicated that control measures are required to reduce the incidence of MDR gram-positive bacteria in this patient population.…”

Section: Discussionsupporting

confidence: 87%

Bacterial and Fungal Infections in the Early Post-transplantation Period After Simultaneous Pancreas-kidney Transplantation: Etiological Agents and Their Susceptibility

Kawecki

Kwiatkowski

Sawicka-Grzelak

et al. 2014

Transplantation Proceedings

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Section: Discussionsupporting

confidence: 87%

Bacterial and Fungal Infections in the Early Post-transplantation Period After Simultaneous Pancreas-kidney Transplantation: Etiological Agents and Their Susceptibility

Kawecki

Kwiatkowski

Sawicka-Grzelak

et al. 2014

Transplantation Proceedings

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“…Another retrospective study of 72 pancreas recipients, all of whom received broad-spectrum antibiotics and fluconazole for 7 days and appropriate prophylaxis for cytomegalovirus, reported an infection rate of 46%, the most common being UTI (17%), intra-abdominal infections (17%), bloodstream infections (18%), surgical site infections (10%), and cytomegalovirus infection (10%) [42]. Similar findings have been reported from other studies [43,44].…”

Section: Uti In Kidney Pancreas Transplant Recipientssupporting

confidence: 73%

“…Improvement in the technical aspects of the surgery and advances in antirejection therapies have resulted in 1-year patient, kidney, and pancreas survival rates of 95% to 98%, 92% to 94%, and 78% to 84%, respectively [41]. However, infection-related morbidity and mortality are common in these patients, in contrast to kidney alone transplant recipients, which can be attributed to the complexity of the surgical techniques, duration of surgery, and structural and metabolic changes that occur in the urinary bladder due to pancreatic secretions [42][43][44][45][46].…”

Section: Uti In Kidney Pancreas Transplant Recipientsmentioning

confidence: 99%

Urinary tract infections in renal transplant recipients

Alangaden

2007

Curr Infect Dis Rep

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Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. Although Escherichia coli remains the most common cause of UTI, Enterococcus spp and drug-resistant Enterobacteriaceae have emerged as important uropathogens in these patients. As a result, symptomatic UTIs warrant pathogen-specific antibiotic therapy guided by culture and susceptibility data. In the early transplant period, prophylaxis of UTI with trimethoprim-sulfamethoxazole is generally effective. Until the natural history and optimal management of asymptomatic bacteruria are better defined, therapy of asymptomatic bacteruria is generally unnecessary.

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“…Not surprisingly, the urinary tract was a frequent site, as in other series. 7,8 After the initial transplantation admission, infection remains an important morbidity factor during patients follow-up. Surgical procedures were the second cause for readmission, as we included all cases: namely ocular, orthopedic, urinary (ureteral stenosis principally), and abdominal surgeries (wound related, intestinal occlusion, peripancreatic collections, etc).…”

Section: Discussionmentioning

confidence: 99%

Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-up

Martins

Henriques

Dias

et al. 2010

Transplantation Proceedings

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Over 9 years, we have performed 93 simultaneous pancreas-kidney transplants (SPKT). The morbidity of this procedure is high compared with kidney transplantation alone; readmissions are frequent and costs are higher. Herein we have presented the complications during follow-up of these 93 patients. Their mean age was 34 Ϯ 6 years and prior dialysis time was 32 Ϯ 25 months. The median hospital stay on the first admission for the transplant procedure was 22 days, including 2 days in the intensive care unit. Bleeding, thrombosis, and infection were the most frequent reasons for prolonged hospitalization. Thirty patients underwent Ն1 surgical reinterventions. Incidence of acute rejection episodes was 11.8%. After discharge, 74.2% of the patients had 197 readmission episodes with infection being the main cause, urinary tract infections, the most frequent; however, systemic viral and fungal infections required the longest readmission periods. The need for surgical interventions, graft dysfunction, and vascular problems were the remaining causes of readmission. At the end of follow-up, 87 patients were alive, 86 with well-functioning kidneys and 74 with normal functioning pancreata. Global survival rates for patient, kidney, and pancreas were 96%, 95%, and 81% at 1-year; 93%, 90%, and 79% at 5-years; and 93%, 90% and 79% at 9-years. Although pancreas-kidney transplant patients are complex presenting many management difficulties, our overall results represent a positive stimulus for diabetic patients. S imultaneous pancreas-kidney transplantation (SPKT)display greater morbidity, length of admission, and number of complications when compared to kidney transplantation alone (KTA), leading to higher costs. However, SPKT remains the best treatment option for good longterm results among type 1 diabetic patients with chronic kidney failure. A recently published review of 1000 SPKT from a single center 1 reinforced this position statement of the American Diabetes Association. We have presented herein the results of our SPKT program, including the rate and type of complications, causes of surgical reinterventions, and readmission episodes after the initial discharge. PATIENTS AND METHODSFrom May 2000 to May 2009, we performed 93 SPKT always using enteric diversion and vascular anastomoses to the systemic circulation. Immunosuppression included antithymocyte globulin (ATG) tacrolimus, mycophenolate mofetil (MMF), and steroids. After the 6th month, it was our policy to progressively taper steroids to complete withdrawal whenever possible. Infection prophylaxis comprised vancomycin, fluconazole, and a third-generation cephalosporin in the first days, with contrimoxazole and valgancyclovir thereafter. We also prescribed aspirin and low-molecularweight heparin as soon as possible after surgery, if there were no bleeding complications. RESULTSThe mean age of the 93 patients was 34 Ϯ 6 years with a 23 Ϯ 5.5 years, duration of diabetes. They had been on dialysis for 32 Ϯ 25 months excepting 4 who were grafted preemptively. Twenty...

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Simultaneous pancreas-kidney transplantation: infectious complications and microbiological aspects

Cited by 38 publications

References 5 publications

Bacterial and Fungal Infections in the Early Post-transplantation Period After Simultaneous Pancreas-kidney Transplantation: Etiological Agents and Their Susceptibility

Bacterial and Fungal Infections in the Early Post-transplantation Period After Simultaneous Pancreas-kidney Transplantation: Etiological Agents and Their Susceptibility

Urinary tract infections in renal transplant recipients

Pancreas-Kidney Transplantation: Complications and Readmissions in 9-Years of Follow-up

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