Surgical Complications are the Main Cause of Pancreatic Allograft Loss in Pancreas-Kidney Transplant Recipients

Sansalone, C. V.; Maione, G; Aseni, Paolo; Mangoni, I.; Roberto, A. De; Soldano, S.; Minetti, Enrico; Broggi, M L; Civati, G

doi:10.1016/j.transproceed.2005.06.103

Cited by 43 publications

(30 citation statements)

References 3 publications

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“…39 Repeated laparotomy may be required in up to 50% of patients. 40,41 The pancreatic graft survival at 1 year may range from 74% to 88%, with the sharpest drop during the first year. 7,39,42 The reported 10-year and 20-year survival rates were 63% and 36%, respectively.…”

Section: Complications Of Simultaneous Pancreas and Kidney Transplantmentioning

confidence: 99%

“…7 Most complications occur within the first 60 days of operation and include graft pancreatitis (3%-12%), infection/abscess (1%-5%), focal/diffuse necrosis (12%), graft-vessel thrombosis (6%-17%), anastomotic leak (0.5%-2%), and intra-abdominal haemorrhage (0%-0.5%). [39][40][41][42][43] Venous thrombosis has been reported to be the most common cause of graft failure; graft pancreatitis and focal/diffuse necrosis were the most common causes of mortality among graft-specific complications. 39,40 Complications related to the transplanted kidney include acute tubular necrosis (ATN) or graft rejection, urinary complications, infection, and vascular thrombosis.…”

Section: Complications Of Simultaneous Pancreas and Kidney Transplantmentioning

confidence: 99%

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Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

et al. 2016

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Objectives: To review the outcome following simultaneous pancreas and kidney transplantation in patients with type 1 diabetes mellitus and endstage renal disease, as well as those with type 2 diabetes mellitus, and to discuss the applicability of this treatment in this locality. Methods:A systematic literature review was performed by searching the PubMed and Elsevier databases. The search terms used were "simultaneous pancreas and kidney transplantation", "diabetes", "pancreas transplant" and "SPK". Original and major review articles related to simultaneous pancreas and kidney transplantation were reviewed. Papers published in English after 1985 were included. Clinical outcomes following transplantation were extracted for comparison between different treatment methods. Outcomes of simultaneous pancreas and kidney transplant and other transplantation methods were identified and categorised into patient survival, graft survival, diabetic complications, and quality of life. Patient survivals and graft survivals were also compared. Results

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Section: Complications Of Simultaneous Pancreas and Kidney Transplantmentioning

confidence: 99%

Section: Complications Of Simultaneous Pancreas and Kidney Transplantmentioning

confidence: 99%

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

et al. 2016

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“…The enteric drainage of the pancreas was created using a circular stapler to anastomose the donor duodenum to the proximal small bowel of the recipient (13). SPK transplants were performed with ipsilateral placement of both organs as described elsewhere (14 (6,18). As outcomes have improved, retransplantation has become a viable option to restore glycemic control (8).…”

Section: Thrombosis Accounts For More Than One-half Of These Technimentioning

confidence: 99%

Immediate Retransplantation for Pancreas Allograft Thrombosis

Hollinger

Powelson²,

Mangus³

et al. 2009

American Journal of Transplantation

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Early pancreas allograft failure most commonly results from thrombosis and requires immediate allograft pancreatectomy. Optimal timing for retransplantation remains undefined. Immediate retransplantation facilitates reuse of the same anatomic site before extensive adhesions have formed. Some studies suggest that early retransplantation is associated with a higher incidence of graft loss. This study is a retrospective review of immediate pancreas retransplants performed at a single center. All cases of pancreas allograft loss within 2 weeks were examined. Of 228 pancreas transplants, 12 grafts were lost within 2 weeks of surgery. Eleven of these underwent allograft pancreatectomy for thrombosis. One suffered anoxic brain injury and was not a retransplantation candidate, one was retransplanted at 3.5 months and nine patients underwent retransplantation 1-16 days following the original transplant. Of the nine early retransplants, one pancreas was lost to heparin-induced thrombocytopenia, one recipient died with function at 2.9 years and the other grafts continue to function at 76-1137 days (mean 572 days). One-year graft survival for early retransplantation was 89% compared to 91% for all pancreas transplants at our center. Immediate retransplantation following pancreatic graft thrombosis restores durable allograft function with outcomes comparable to first-time pancreas transplantation.

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“…De acordo com os dados da UNOS, no primeiro ano, 45% dos pacientes submetidos ao TSPR não apresentam rejeição aguda, 36% têm rejeição aguda apenas renal, 3% têm rejeição aguda apenas pancreática e 16% apresentam rejeição aguda nos dois enxertos (33) (34,35).…”

Section: Transplante De Pâncreas E Ilhotas No Dmunclassified

“…As perdas técnicas incluem trombose (52%), pancreatite (20,3%), infecções (18,7%), fístulas (6,5%) e sangramento (2,4%) e estão associadas ao índice de massa corpórea do receptor maior que 30 kg/m 2 , ao tempo de isquemia fria do pâncreas maior que 24 horas e à causa de morte cerebral do doador que não seja atribuída a trauma (38). O TSPR está associado a elevadas taxas de complicações pós-operatórias, de modo que cerca 16% a 43% dos pacientes necessitam de relaparotomias para abordagem de complicações do pâncreas (39)(40)(41). Além disso, as complicações sépticas são mais freqüentes nos casos de TSPR do que nas outras modalidades de transplante pancreático (40).…”

Section: Transplante De Pâncreas E Ilhotas No Dmunclassified

Transplante de pâncreas e ilhotas em portadores de diabetes melito

Sá

Gonzalez

Melaragno

et al. 2008

Arq Bras Endocrinol Metab

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O transplante simultâneo de pâncreas/rim tem indicações específicas, riscos e benefícios. O procedimento, cada vez mais realizado, traz vantagens se comparado ao paciente em diálise, em relação à qualidade de vida, anos de vida ganhos e evolução das complicações crônicas. Se o paciente tiver a opção de realizar o transplante de rim com doador vivo, que apresenta sobrevida semelhante do enxerto e do paciente aos dez anos, o procedimento deverá ser considerado. O transplante de pâncreas após rim, quando efetivo, pode melhorar a evolução das complicações cardiovasculares, mas em contrapartida provoca maior mortalidade nos primeiros meses após a cirurgia. O transplante isolado de pâncreas também ocasiona a maior mortalidade pós-operatória, resultado da complexidade do procedimento e da imunossupressão. O transplante de ilhotas tem sua indicação para um seleto grupo de diabéticos com instabilidade glicêmica.

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Surgical Complications are the Main Cause of Pancreatic Allograft Loss in Pancreas-Kidney Transplant Recipients

Cited by 43 publications

References 3 publications

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

Immediate Retransplantation for Pancreas Allograft Thrombosis

Transplante de pâncreas e ilhotas em portadores de diabetes melito

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