The Value of Graft Implantation Sequence in Simultaneous Pancreas-Kidney Transplantation on the Outcome and Graft Survival

Abstract

Background/Objectives: The sequence of graft implantation in simultaneous pancreas-kidney transplantation (SPKT) warrants additional study and more targeted focus, since little is known about the short- and long-term effects on the outcome and graft survival after transplantation. Material and methods: 103 patients receiving SPKT in our department between 1999 and 2015 were included in the study. Patients were divided according to the sequence of graft implantation into pancreas-first (PF, n = 61) and kidney-first (KF, n = 42) groups. Clinicopathological characteristics, outcome and survival were reviewed retrospectively. Results: Donor and recipient characteristics were similar. Rates of post-operative complications and graft dysfunction were significantly higher in the PF group compared with the KF group (episodes of acute rejection within the first year after SPKT: 11 (18%) versus 2 (4.8%); graft pancreatitis: 18 (18%) versus 2 (4.8%), p = 0.04; vascular thrombosis of the pancreas: 9 (14.8%) versus 1 (2.4%), p = 0.03; and delayed graft function of the kidney: 12 (19.6%) versus 2 (4.8%), p = 0.019). The three-month pancreas graft survival was significantly higher in the KF group (PF: 77% versus KF: 92.1%; p = 0.037). No significant difference was observed in pancreas graft survival five years after transplantation (PF: 71.6% versus KF: 84.8%; p = 0.104). Kidney graft survival was similar between the two groups. Multivariate analysis revealed order of graft implantation as an independent prognostic factor for graft survival three months after SPKT (HR 2.6, 1.3–17.1, p = 0.026) and five years (HR 3.7, 2.1–23.4, p = 0.040). Conclusion: Our data indicates that implantation of the pancreas prior to the kidney during SPKT has an influence especially on the early-post-operative outcome and survival rate of pancreas grafts.

Analysis of Volatile Anesthetic-Induced Organ Protection in Simultaneous Pancreas–Kidney Transplantation

“…Depending on timing and application, it can be referred to as pre-, peri-, and postconditioning. In this context, ischemic preconditioning and remote ischemic preconditioning have shown beneficial effects in solid organ transplantation, including SPKT [ 37 ]. This describes the phenomenon whereby brief episodes of ischemia and reperfusion applied in distant tissues, for instance, the lower extremity, render organs subsequently subject to transplantation more resistant to ischemia.…”

“…“Note: This study has partially analysed data of a prospectively collected database with informations of transplant candidates and transplant recipients after pancreas transplantation. In parts, it has been previously published [ 11 , 33 , 34 , 35 , 36 , 37 ]. However, these publications considered different inclusion criterias, answered other specific questions (SPKT for type 1 versus type 2 diabetes mellitus, order of graft implantation, type of dialysis modalities etc.)…”

Correlation of Different Serum Biomarkers with Prediction of Early Pancreatic Graft Dysfunction Following Simultaneous Pancreas and Kidney Transplantation

“…Depending on timing and application, it can be referred to as pre-, peri-and post-conditioning [32,59]. Herein, ischemic preconditioning and remote ischemic preconditioning have previously been shown to induce beneficial effects in solid organ transplantation including SPKT [60]. Insights into the molecular pathophysiology of IRI and subsequent early graft dysfunction have opened the door to new therapeutic targets and novel interventions, such as succinate removal, ferroptosis inhibitors, regulation of complement cascade and manipulation of regulatory cells, such as myeloid-derived suppressor cells (MDSC) and hematopoietic stem cells (HSC), which may play an important role in reducing early graft dysfunction after transplantation [2].…”

Progress and Recent Advances in Solid Organ Transplantation

“…In this Special Issue, "Progress and Recent Advances in Solid Organ Transplantation", researchers from different disciplines with different expertise and resources highlighted the novelty of their recent investigations in the field of organ transplantation, including issues related to donors, allografts, and patient survival [8][9][10][11][12][13][14][15][16][17][18][19][20]. While there have been significant advances in regional and national kidney paired-donation programs in matching incompatible pairs, data suggest that there may be a role for desensitization in select cases to facilitate organ transplantation [21].…”