Surgical complications and renal function after kidney alone or simultaneous pancreas-kidney transplantation: a matched comparative study

Gutiérrez, Pedro; Marrero, Domingo Hernández; Hernández, Domingo; Vivancos, Sofía; Pérez-Tamajón, Lourdes; Vera, J.M. Rodriguez De; Alarcó, Antonio; González-Posada, José Manuel

doi:10.1093/ndt/gfl771

Cited by 14 publications

(11 citation statements)

References 16 publications

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“…A Brazilian study reported 22.7% incidence of delayed kidney function in a cohort of simultaneous pancreas-kidney transplants, despite a short mean cold ischemia time of 14h and the use of ideal donors [7]. With similar demographics, international cohorts reported incidences of 4-5% [8,9]. Notable, similar to demonstrated in American and European cohorts, DGF in Brazilian transplant recipients has negative impact on short and long-term outcomes [4,6,10].…”

Section: Introductionmentioning

confidence: 91%

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis

et al. 2020

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BackgroundThis study evaluated the risk factors for delayed graft function (DGF) in a country where its incidence is high, detailing donor maintenance-related (DMR) variables and using machine learning (ML) methods beyond the traditional regression-based models. MethodsA total of 443 brain dead deceased donor kidney transplants (KT) from two Brazilian centers were retrospectively analyzed and the following DMR were evaluated using predictive modeling: arterial blood gas pH, serum sodium, blood glucose, urine output, mean arterial pressure, vasopressors use, and reversed cardiac arrest. ResultsMost patients (95.7%) received kidneys from standard criteria donors. The incidence of DGF was 53%. In multivariable logistic regression analysis, DMR variables did not impact on DGF occurrence. In post-hoc analysis including only KT with cold ischemia time<21h (n = 220), urine output in 24h prior to recovery surgery (OR = 0.639, 95%CI 0.444-0.919) and serum sodium (OR = 1.030, 95%CI 1.052-1.379) were risk factors for DGF. Using elastic net regularized regression model and ML analysis (decision tree, neural network and support vector machine), urine output and other DMR variables emerged as DGF predictors: mean arterial pressure, � 1 or high dose vasopressors and blood glucose.

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Section: Introductionmentioning

confidence: 91%

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis

et al. 2020

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“…Moreover, as for the improvement in mental summary scores in SPK patients, KTA is unlikely to remove the worry caused by daily hypoglycemia in patients with T1DM, and the KTA patients in this study included those also waiting for pancreas transplantation, presumably leading to a lack of satisfaction with having had only a kidney transplant. On the other hand, SPK may have a negative impact on the QOL because of the difficulty associated with the surgical technique, a higher re-operation rate than KTA, more frequent postoperative complications associated with a pancreas graft (including graft pancreatitis), and longer hospital stays [22]. Indeed, in the current study, 6 patients undergoing SPK required re-operation due to postoperative surgical complications, including venous thrombosis, leak, hemorrhage, or dehiscence.…”

Section: Discussionmentioning

confidence: 70%

Quality of life in Japanese patients with type 1 diabetes and end-stage renal disease undergoing simultaneous pancreas and kidney transplantation

et al. 2017

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We conducted this cross-sectional study to assess quality of life (QOL) in Japanese patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD) undergoing simultaneous pancreas and kidney transplantation (SPK). Japanese patients with T1DM without diabetic nephropathy (N = 10), and those undergoing chronic dialysis (N = 52), kidney transplantation alone (KTA, N = 25), and SPK (N = 16) were studied. Comprehensive health-related QOL was assessed using the Short Form 36 version 2 (SF-36v2). Emotional functioning in diabetes was measured by the Problem Area In Diabetes (PAID) scale. Severity of impaired hypoglycemic awareness was assessed using the Clarke hypoglycemic score. SPK patients had significantly higher (or tended to have higher) subscale and summary SF-36 scores than dialysis patients and KTA patients. PAID scores were significantly lower in SPK patients than in dialysis patients and KTA patients. Clarke hypoglycemic scores were also significantly lower in SPK patients than dialysis patients. In KTA and dialysis patients, there were no significant differences in the SF-36 subscale/summary scores, PAID scores, or Clarke hypoglycemic scores. In conclusion, QOL for Japanese patients receiving SPK may be superior to that of dialysis patients and KTA patients. Whether SPK actually improves QOL needs to be clarified in longitudinal studies.

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“…This analysis is limited by our inability to determine whether the reduction in survival was the result of a complication from the graft loss itself or from the loss of function over time. The natural experiment observed using this method eliminated the major weaknesses of previous studies: selection bias of comparison of SPK and isolated renal transplant recipients who may differ in both patient and donor characteristics (2–9). One could argue that the independent value of each allograft might be difficult to isolate because of the interactive processes between both organs (such as a reduction in rejection due to the presence of an additional organ).…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have questioned the incremental benefit of the pancreas allograft compared with kidney transplant alone for the uremic diabetic patients (2–9). This study aims to quantify the incremental value of the pancreas allograft function to the survival of SPK transplant recipients.…”

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confidence: 99%

Incremental Value of the Pancreas Allograft to the Survival of Simultaneous Pancreas-Kidney Transplant Recipients

et al. 2009

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OBJECTIVE To quantify the incremental survival benefit of the pancreas allograft in simultaneous pancreas-kidney (SPK) transplant recipients. RESEARCH DESIGN AND METHODS Data from the national transplant database from 2000 to 2007 were analyzed. SPK recipients who had functioning allografts to 1-year post transplant (n = 3,304) were compared with those who had failure of the renal (n = 233) or pancreatic (n = 112) graft. The main outcome was a projection of 10 life-years of patient survival beyond the first transplant anniversary. RESULTS Recipients with function of both organs accrued 9.4 life-years following transplantation. Projected survival in patients with kidney failure was reduced to 2.5 life-years. Pancreas failure reduced predicted survival to 8 life-years. Renal allograft failure impacts life expectancy significantly (adjusted hazard ratio [aHR] 12.13). However, pancreas allograft failure was also associated with reduced survival (aHR 2.62). CONCLUSIONS Although the majority of the survival benefit of SPK transplant is due to the renal transplant, pancreas allograft function does contribute to patient survival.

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Surgical complications and renal function after kidney alone or simultaneous pancreas-kidney transplantation: a matched comparative study

Abstract: In the modern transplant era, SPKT in ESRD diabetic patients, offers a slightly better short-term kidney allograft function without significant increase in surgical morbidity, compared with CKTA.

Cited by 14 publications

References 16 publications

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis

The impact of deceased donor maintenance on delayed kidney allograft function: A machine learning analysis

Quality of life in Japanese patients with type 1 diabetes and end-stage renal disease undergoing simultaneous pancreas and kidney transplantation

Incremental Value of the Pancreas Allograft to the Survival of Simultaneous Pancreas-Kidney Transplant Recipients

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