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Malik AK, Tingle SJ, Chung N, Owen R, Mahendran B, Counter C, Sinha S, Muthasamy A, Sutherland A, Casey J, Drage M, van Dellen D, Callaghan CJ, Elker D, Manas DM, Pettigrew GJ, Wilson CH, White SA. The impact of time to death in donors after circulatory death on recipient outcome in simultaneous pancreas-kidney transplantation. Am J Transplant 2024; 24:1247-1256. [PMID: 38360185 DOI: 10.1016/j.ajt.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/27/2024] [Accepted: 02/07/2024] [Indexed: 02/17/2024]
Abstract
The time to arrest donors after circulatory death is unpredictable and can vary. This leads to variable periods of warm ischemic damage prior to pancreas transplantation. There is little evidence supporting procurement team stand-down times based on donor time to death (TTD). We examined what impact TTD had on pancreas graft outcomes following donors after circulatory death (DCD) simultaneous pancreas-kidney transplantation. Data were extracted from the UK transplant registry from 2014 to 2022. Predictors of graft loss were evaluated using a Cox proportional hazards model. Adjusted restricted cubic spline models were generated to further delineate the relationship between TTD and outcome. Three-hundred-and-seventy-five DCD simultaneous kidney-pancreas transplant recipients were included. Increasing TTD was not associated with graft survival (adjusted hazard ratio HR 0.98, 95% confidence interval 0.68-1.41, P = .901). Increasing asystolic time worsened graft survival (adjusted hazard ratio 2.51, 95% confidence interval 1.16-5.43, P = .020). Restricted cubic spline modeling revealed a nonlinear relationship between asystolic time and graft survival and no relationship between TTD and graft survival. We found no evidence that TTD impacts pancreas graft survival after DCD simultaneous pancreas-kidney transplantation; however, increasing asystolic time was a significant predictor of graft loss. Procurement teams should attempt to minimize asystolic time to optimize pancreas graft survival rather than focus on the duration of TTD.
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Affiliation(s)
- Abdullah K Malik
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK.
| | - Samuel J Tingle
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK
| | - Nicholas Chung
- Northumbria Healthcare NHS Foundation Trust, Cramlington, UK
| | - Ruth Owen
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Balaji Mahendran
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK
| | | | - Sanjay Sinha
- Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | | | - John Casey
- Edinburgh Royal Infirmary, Edinburgh, UK
| | - Martin Drage
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Chris J Callaghan
- NHS Blood and Transplant, Bristol, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Doruk Elker
- Cardiff and Vale University Health Board, Cardiff, UK
| | - Derek M Manas
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK; NHS Blood and Transplant, Bristol, UK
| | - Gavin J Pettigrew
- NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Colin H Wilson
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK
| | - Steven A White
- Institute of Transplantation, Freeman Hospital, Newcastle upon Tyne, UK; NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, Cambridge, UK; NHS Blood and Transplant, Bristol, UK
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2
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Moein M, Maloney B, Baio S, Bahreini A, Abedini M, Abedini M, Saidi RF. Pancreas after kidney transplantation, is it the time to overcome the stigma? World J Surg 2024; 48:1501-1508. [PMID: 38682645 DOI: 10.1002/wjs.12191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Accepted: 04/08/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Pancreas transplantation is the most effective treatment to improve quality of life and overcome complications in patients with end-stage renal disease and diabetes mellitus. One of the main approaches for concurrent renal disease and diabetes mellitus which has been underutilized during the past decade is a pancreas transplant after kidney transplantation. Our study aimed to quantify outcomes following pancreas after kidney transplants (PAKs) in the United States from 2001 to 2020 with an emphasis on graft and patient survival. METHODS AND MATERIALS A retrospective registry analysis was performed by accessing the OPTN/UNOS database for PAKs that were performed in the United States from January 2001 to April 2020. The study population was divided into two subgroups: patients receiving a pancreas transplant between 2001 and 2010 and those receiving a pancreas transplant between 2011 and 2020. RESULTS The study examined a total number of 3706 PAK recipients; patients who received a PAK from January 2001 through December 2010 (n = 2892) and those who received a PAK from January 2011 to April 2020 (n = 814). The selection process of transplant recipients did not drastically change throughout the 2001-2010 and 2011-2020 periods. Length of stay at the hospital after the transplantation improved significantly in the 2011-2020 group relative to the 2001-2010 group (8.48 vs. 10.08 days, mean, p < 0.01). Additionally, more transplantation with 4-6 human leukocyte antigen mismatch occurred in the 2011-2020 group than in the 2001-2010 group (80.6% vs. 71.4%, p < 0.01). The pancreas preservation time of 13.35 h in the 2001-2010 group decreased significantly to 11.17 h in the 2011-2020 group (p < 0.001). The mean donor's amylase and lipase also decreased significantly in the 2011-2020 cohort. Significant graft survival improvement was observed in the 2011-2020 group compared to the 2001-2010 group after a long-term follow-up (p < 0.001). The mean Calculated Pancreas Donor Risk Index was 1.08 for the 2001-2010 group and 0.99 for the 2011-2020 group with a significant difference (p < 0.001). CONCLUSION The beneficial results and improved outcomes observed in PAK patients demonstrate the effectiveness of the operation for individuals in need of a pancreas transplant. PAKs can prove to be a meaningful solution to overcome long waiting times, decrease the donor-recipient imbalance, expand the donor pool, and overcome the current underutilization in order to improve the short- and long-term quality of life in the groups of interest.
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Affiliation(s)
- Mahmoudreza Moein
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Brendan Maloney
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Stephen Baio
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Amin Bahreini
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Marjan Abedini
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Mahsa Abedini
- Department of Medical and Serological Sciences, University of Bologna, Bologna, Italy
| | - Reza F Saidi
- Division of Transplant Services, Department of Surgery, SUNY Upstate Medical University, Syracuse, New York, USA
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Drachenberg CB, Buettner-Herold M, Aguiar PV, Horsfield C, Mikhailov AV, Papadimitriou JC, Seshan SV, Perosa M, Boggi U, Uva P, Rickels M, Grzyb K, Arend L, Cuatrecasas M, Toniolo MF, Farris AB, Renaudin K, Zhang L, Roufousse C, Gruessner A, Gruessner R, Kandaswamy R, White S, Burke G, Cantarovich D, Parsons RF, Cooper M, Kudva YC, Kukla A, Haririan A, Parajuli S, Merino-Torres JF, Argente-Pla M, Meier R, Dunn T, Ugarte R, Rao JS, Vistoli F, Stratta R, Odorico J. Banff 2022 pancreas transplantation multidisciplinary report: Refinement of guidelines for T cell-mediated rejection, antibody-mediated rejection and islet pathology. Assessment of duodenal cuff biopsies and noninvasive diagnostic methods. Am J Transplant 2024; 24:362-379. [PMID: 37871799 DOI: 10.1016/j.ajt.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/02/2023] [Accepted: 10/11/2023] [Indexed: 10/25/2023]
Abstract
The Banff pancreas working schema for diagnosis and grading of rejection is widely used for treatment guidance and risk stratification in centers that perform pancreas allograft biopsies. Since the last update, various studies have provided additional insight regarding the application of the schema and enhanced our understanding of additional clinicopathologic entities. This update aims to clarify terminology and lesion description for T cell-mediated and antibody-mediated allograft rejections, in both active and chronic forms. In addition, morphologic and immunohistochemical tools are described to help distinguish rejection from nonrejection pathologies. For the first time, a clinicopathologic approach to islet pathology in the early and late posttransplant periods is discussed. This update also includes a discussion and recommendations on the utilization of endoscopic duodenal donor cuff biopsies as surrogates for pancreas biopsies in various clinical settings. Finally, an analysis and recommendations on the use of donor-derived cell-free DNA for monitoring pancreas graft recipients are provided. This multidisciplinary effort assesses the current role of pancreas allograft biopsies and offers practical guidelines that can be helpful to pancreas transplant practitioners as well as experienced pathologists and pathologists in training.
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Affiliation(s)
| | - Maike Buettner-Herold
- Department of Nephropathology, Institute of Pathology, Friedrich-Alexander-University Erlangen-Nuremberg (FAU) and University Hospital, Erlangen, Germany
| | | | - Catherine Horsfield
- Department of Histopathology/Cytology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Alexei V Mikhailov
- Department of Pathology, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - John C Papadimitriou
- Department of Pathology, University of Maryland School of Medicine, Maryland, USA
| | - Surya V Seshan
- Division of Renal Pathology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, Cornell University, New York, New York, USA
| | - Marcelo Perosa
- Beneficência Portuguesa and Bandeirantes Hospital of São Paulo, São Paulo, Brazil
| | - Ugo Boggi
- Department of Surgery, University of Pisa, Pisa, The province of Pisa, Italy
| | - Pablo Uva
- Kidney/Pancreas Transplant Program, Instituto de Trasplantes y Alta Complejidad (ITAC - Nephrology), Buenos Aires, Argentina
| | - Michael Rickels
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Philadelphia, USA
| | - Krzyztof Grzyb
- Department of Pathology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lois Arend
- Department of Pathology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Alton B Farris
- Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Lizhi Zhang
- Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Candice Roufousse
- Department of Immunology and Inflammation, Imperial College of London, London, United Kingdom
| | - Angelika Gruessner
- Department of Nephrology/Medicine, State University of New York, New York, USA
| | - Rainer Gruessner
- Department of Surgery, State University of New York, New York, USA
| | - Raja Kandaswamy
- Division of Solid Organ Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Steven White
- Department of Surgery, Newcastle Upon Tyne NHS Foundation Trust, Newcastle upon Tyne, England, United Kingdom
| | - George Burke
- Division of Kidney-Pancreas Transplantation, Department of Surgery, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, Florida, USA
| | | | - Ronald F Parsons
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Cooper
- Division of Transplant Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Yogish C Kudva
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Aleksandra Kukla
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic College of Medicine and Science, Mayo Clinic, Rochester, Minnesota, USA
| | - Abdolreza Haririan
- Department of Medicine, University of Maryland School of Medicine, Maryland, USA
| | - Sandesh Parajuli
- Department of Medicine, UWHealth Transplant Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Juan Francisco Merino-Torres
- Department of Endocrinology and Nutrition, University Hospital La Fe, La Fe Health Research Institute, University of Valencia, Valencia, Spain
| | - Maria Argente-Pla
- University Hospital La Fe, Health Research Institute La Fe, Valencia, Spain
| | - Raphael Meier
- Department of Surgery, University of Maryland School of Medicine, Maryland, USA
| | - Ty Dunn
- Division of Transplantation, Department of Surgery, Penn Transplant Institute, University of Pennsylvania, Pennsylvania, Philadelphia, USA
| | - Richard Ugarte
- Department of Medicine, University of Maryland School of Medicine, Maryland, USA
| | - Joseph Sushil Rao
- Division of Solid Organ Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA; Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Fabio Vistoli
- Department of Surgery, University of Pisa, Pisa, The province of Pisa, Italy
| | - Robert Stratta
- Department of Surgery, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Jon Odorico
- Division of Transplantation, Department of Surgery, UWHealth Transplant Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Lega IC, Yale JF, Chadha A, Paty B, Roscoe R, Snider M, Steier J, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Senior P, Rabi D, Sherifali D. Hypoglycemia in Adults. Can J Diabetes 2023; 47:548-559. [PMID: 37821214 DOI: 10.1016/j.jcjd.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
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Doherty DT, Tan J, McFarlane R, Kingston J, Khambalia HA, Augustine T, Moinuddin Z, van Dellen D. Jejunal or Ileal Exocrine Drainage in Pancreas Transplantation: Impact on Gastrointestinal Function. EXP CLIN TRANSPLANT 2023; 21:586-591. [PMID: 37584539 DOI: 10.6002/ect.2022.0342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/17/2023]
Abstract
OBJECTIVES Pancreas transplant can have serious complications requiring salvage pancreatectomy, and surgical approaches should be carefully considered, with jejunal or ileal anastomoses most often employed. The jejunum may reduce gastrointestinal disturbance, whereas the ileum is more immunogenic. Proximal gastrointestinal anastomoses pose challenges with salvage pancreatectomy and creation of high-output stoma, often in the context of end-stage renal failure. Here, we compared outcomes between these techniques. MATERIALS AND METHODS We retrospectively analyzed patient records of simultaneous pancreas and kidney transplants at a single center between 2013 and 2015, with follow-up to 2020. RESULTS Our center performed 86 simultaneous pancreas and kidney transplants during the study period; 10 patients were excluded because of incomplete records of anastomosis type. Of included recipients, 59.2% were men (mean age 41.5 ± 8.4 y), 72.4% were donors after brain death, and 98.7% had received a first pancreas transplant. Forty-three simultaneous pancreas and kidney transplants were performed with ileal anastomosis and 33 with jejunal anastomosis. We found no significant differences in recipient or donor factors or immunosuppression regimen between anastomosis groups and no significant differences in overall patient, pancreas, or kidney graft survival or in gastrointestinal complications. Hospital length of stay was higher with ileal anastomosis (median 14 vs 19 days; P < .05), as was cold ischemic time (median 8:48 vs 9:31 hours; P < .05). Three patients required salvage pancre-atectomy and loop ileostomy formation with multiorgan support, prolonged intensive care unit stay, relaparotomy, and/or laparostomy. CONCLUSIONS Long-term outcomes were comparable between our patient groups. Catastrophic complica-tions occur in a minority of cases, requiring salvage surgery. More complications occurred with ileal anastomosis, but this approach allows graft pancreatectomy and formation of loop ileostomy, avoiding a more proximal stoma in clinically unstable patients. Further studies are needed to examine the impact of enteric anastomosis site.
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Affiliation(s)
- Daniel T Doherty
- From the Department of Renal and Pancreatic Transplantation, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
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Marfil-Garza BA, Hefler J, Verhoeff K, Lam A, Dajani K, Anderson B, O'Gorman D, Kin T, Bello-Chavolla OY, Grynoch D, Halpin A, Campbell PM, Senior PA, Bigam D, Shapiro AMJ. Pancreas and Islet Transplantation: Comparative Outcome Analysis of a Single-centre Cohort Over 20-years. Ann Surg 2023; 277:672-680. [PMID: 36538619 DOI: 10.1097/sla.0000000000005783] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To provide the largest single-center analysis of islet (ITx) and pancreas (PTx) transplantation. SUMMARY BACKGROUND DATA Studies describing long-term outcomes with ITx and PTx are scarce. METHODS We included adults undergoing ITx (n=266) and PTx (n=146) at the University of Alberta from January 1999 to October 2019. Outcomes include patient and graft survival, insulin independence, glycemic control, procedure-related complications, and hospital readmissions. Data are presented as medians (interquartile ranges, IQR) and absolute numbers (percentages, %) and compared using Mann-Whitney and χ2 tests. Kaplan-Meier estimates, Cox proportional hazard models and mixed main effects models were implemented. RESULTS Crude mortality was 9.4% and 14.4% after ITx and PTx, respectively ( P= 0.141). Sex-adjusted and age-adjusted hazard-ratio for mortality was 2.08 (95% CI, 1.04-4.17, P= 0.038) for PTx versus ITx. Insulin independence occurred in 78.6% and 92.5% in ITx and PTx recipients, respectively ( P= 0.0003), while the total duration of insulin independence was 2.1 (IQR 0.8-4.6) and 6.7 (IQR 2.9-12.4) year for ITx and PTx, respectively ( P= 2.2×10 -22 ). Graft failure ensued in 34.2% and 19.9% after ITx and PTx, respectively ( P =0.002). Glycemic control improved for up to 20-years post-transplant, particularly for PTx recipients (group, P= 7.4×10 -7 , time, P =4.8×10 -6 , group*time, P= 1.2×10 -7 ). Procedure-related complications and hospital readmissions were higher after PTx ( P =2.5×10 -32 and P= 6.4×10 -112 , respectively). CONCLUSIONS PTx shows higher sex-adjusted and age-adjusted mortality, procedure-related complications and readmissions compared with ITx. Conversely, insulin independence, graft survival and glycemic control are better with PTx. This study provides data to balance risks and benefits with ITx and PTx, which could improve shared decision-making.
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Affiliation(s)
- Braulio A Marfil-Garza
- Department of Surgery
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- CHRISTUS-LatAm Hub - Excellence and Innovation Center, Monterrey, Mexico
| | | | | | - Anna Lam
- Clinical Islet Transplant Program
- Department of Medicine, Division of Endocrinology and Metabolism
| | - Khaled Dajani
- Department of Surgery
- Clinical Islet Transplant Program
| | | | | | - Tatsuya Kin
- Department of Surgery
- Clinical Islet Transplant Program
| | | | - Donald Grynoch
- Histocompatibility Laboratory, Department of Laboratory Medicine and Pathology, University of Alberta
| | - Anne Halpin
- Histocompatibility Laboratory, Department of Laboratory Medicine and Pathology, University of Alberta
| | - Patricia M Campbell
- Histocompatibility Laboratory, Department of Laboratory Medicine and Pathology, University of Alberta
| | - Peter A Senior
- Clinical Islet Transplant Program
- Department of Medicine, Division of Endocrinology and Metabolism
- Alberta Diabetes Institute, Edmonton, Canada
| | - David Bigam
- Department of Surgery
- Clinical Islet Transplant Program
| | - A M James Shapiro
- Department of Surgery
- Clinical Islet Transplant Program
- Alberta Diabetes Institute, Edmonton, Canada
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7
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Shirley C, Tatum D, Killackey M, Jeon H, Paramesh A, Vijay A. Balancing Waitlist Dropout in Pancreas Transplantation. Transplant Proc 2023; 55:613-615. [PMID: 36964107 DOI: 10.1016/j.transproceed.2023.02.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/24/2023] [Accepted: 02/24/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND The time a patient spends on the waiting list for a Simultaneous Pancreas-Kidney (SPK) transplant depends on several donor and recipient-specific factors. The average wait-list time for SPK in the United States has been about 1 to 3 years, significantly shorter than the average wait time for kidney-only transplantation. A single-center retrospective analysis of SPK waitlisted candidates was performed to determine the implication of wait-list time on dropout from the wait-list due to death or poor health. METHODS We analyzed all deceased donor Simultaneous Pancreas-Kidney wait-listed candidates between Jan 1994 and June 2021. Waitlisted candidates who got transplanted (TG) were compared to those who dropped out from the wait list due to death or poor health (DPHG). RESULTS In the study period, 297 candidates were waitlisted for SPK transplants. Eight candidates were removed, as transplantation was not needed due to improvement in health while on the waiting list. Fourteen wait-listed candidates transferred to another center were also excluded from the study group. Two hundred and thirty wait-listed candidates were transplanted (TG). Forty-five patients were delisted due to death or poor health (DPHG). The mean body mass index of candidates in TG and DPHG were 25.1 and 24.9, respectively. The mean age at dropout in DPHG was 40.7, similar to the mean age at transplant in TG (39.4). The mean age of diabetes onset was slightly lower in TG (17.4) compared to 20.02 in DPHG. The mean days spent by the candidates on the waitlist in DPHG were significantly higher than those in TG (821 days vs 252 days). Eight of the 45 patients (17.7%) in DPHG had 1 or more organ transplants before listing compared to 1 of 230 patients (0.43%) in TG. Despite low wait times for SPK transplants, increased wait times can account for a dropout from the waitlist due to death or poor health. Centers should exercise caution in wait listing SPK candidates with prior organ transplants.
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Affiliation(s)
- Charles Shirley
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Danielle Tatum
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Mary Killackey
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Hoonbae Jeon
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Anil Paramesh
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana
| | - Adarsh Vijay
- Department of Surgery, Tulane University School of Medicine, New Orleans, Louisiana.
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Amelioration of Diabetes and Neuropathy After Pancreas Transplantation: Measurable Differences in Vibration Perception Thresholds Impact Outcomes. Transplantation 2023; 107:309-310. [PMID: 35969038 DOI: 10.1097/tp.0000000000004276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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9
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Diabetic Neuropathy Is Independently Associated With Worse Graft Outcomes and Incident Cardiovascular Disease After Pancreas Transplantation: A Retrospective Cohort Study in Type 1 Diabetes. Transplantation 2023; 107:475-484. [PMID: 35969040 DOI: 10.1097/tp.0000000000004275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Information about the impact of diabetic neuropathy (DN) on outcomes after pancreas transplantation (PT) is scarce. We assessed the independent relationship between DN markers with both graft survival and incident cardiovascular disease (CVD) after transplantation. METHODS A cohort study in individuals with type 1 diabetes and end-stage kidney disease who underwent PT between 1999 and 2015 was conducted. DN was assessed with vibration perception thresholds (VPTs) and orthostatic hypotension (pre-PT and 6 mo, 2-3, 5-6, and 8-10 y after transplantation). Pretransplantation and posttransplantation DN markers were related with graft failure/dysfunction and incident CVD during follow-up. RESULTS We included 187 participants (70% men, age 39.9 ± 7.1 y, diabetes duration 27.1 y), with a median follow-up of 11.3 y. Abnormal VPTs (≥25 V) were observed in 53%. After transplantation, VPTs improved (22.4 ± 8.4 pretransplant versus 16.1 ± 6.1 V at 8-10 y post-PT; P < 0.001); additionally, the prevalence of abnormal VPTs decreased (53% pretransplant versus 24.4% at 8-10 y; P < 0.001). After adjusting for age, sex, diabetes duration, blood pressure, body mass index, and previous CVD, pretransplant VPTs ≥25 V were independently associated with pancreas graft failure/dysfunction (hazard ratio [HR], 2.01 [1.01-4.00]) and incident CVD (HR, 2.57 [1.17-5.64]). Furthermore, persistent abnormal VPTs after 6 mo posttransplantation were associated with the worst outcomes (HR, 2.80 [1.25-6.23] and HR, 3.19 [1.14-8.96], for graft failure/dysfunction and incident CVD, respectively). CONCLUSIONS In individuals with type 1 diabetes and end-stage kidney disease, PT was associated with an improvement of VPTs. This simple and widely available DN study was independently associated with pancreas graft function and CVD posttransplantation.
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Dong A, Zhang Y, Lu S, Yu W. Influence of Dexmedetomidine on Myocardial Injury in Patients with Simultaneous Pancreas-Kidney Transplantation. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:7196449. [PMID: 36437830 PMCID: PMC9691300 DOI: 10.1155/2022/7196449] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/25/2022] [Accepted: 08/03/2022] [Indexed: 09/09/2023]
Abstract
Background Diabetes is one of the most common chronic diseases in the world. End-stage renal disease (ESRD) caused by diabetes is the most serious long-term complication. The main cause of death in patients with simultaneous pancreas-kidney transplantation (SPKT) is cardiovascular disease. Although dexmedetomidine (Dex) has unique advantages in heart protection against ischaemic/reperfusion injury, few clinical studies have been conducted on its cardioprotective effect in SPKT. This study aimed to explore the influence of Dex on myocardial injury in patients undergoing SPKT and to analyze its possible mechanism. Methods A randomized controlled trial (RCT) was performed from July 1, 2018 to December 1, 2020. Eighty patients, regardless of gender, scheduled for SPKT were randomly allocated into a Dex group (D group) receiving Dex at a rate of 1 µg/kg for 10 minutes before anaesthesia induction and then continuous infusion at 0.5 µg/kg/hour until the end of surgery and control group (C group) receiving equivalent capacity of saline. Serum cardiac troponin I (cTnI), creatine kinase isoenzyme (CK-MB), tumour necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were recorded at 5 minutes after anaesthesia induction (baseline,T0), 5 minutes before renal arteriovenous opening (T1), 30 minutes after renal arteriovenous opening (T2), 30 minutes after pancreatic related arteriovenous opening (T3), immediately after surgery (T4), 4 hours after surgery (T5), and 24 hours after surgery (T6). Adverse cardiovascular events were recorded during the perioperative period. Changes in ECG S-T segments and T waves were monitored at T0-T6. Myocardial infarction and percutaneous coronary intervention were recorded with an average follow-up of one year. Results Compared with T0, TNF-α and IL-6 concentrations significantly increased at T1-T6 in the C and D groups (P < 0.05). IL-6 concentration increased significantly after renal artery opening and reached the peak after the opening of pancreatic blood vessels. Compared with the C group, TNF-α, and IL-6 concentrations were significantly reduced in group D at T2-T6 (P < 0.05). Compared with T0, cTnI and CK-MB concentrations were significantly increased at T3-T6 in the C and D groups (P < 0.05). cTnI and CK-MB concentrations increased significantly after the opening of renal artery, and reached the peak after the opening of pancreatic blood vessels. Compared with the C group, cTnI and CK-MB concentrations were significantly reduced in the D group at T3-T6 (P < 0.05). There was no significant difference in patient characteristics amongst groups, including the proportion of intraoperative vasoactive drug use and adverse cardiovascular events during the follow-up period. Heart rate, mean blood pressure, central venous pressure, and cardiac output were not remarkably different between the two groups at any time point. Conclusions Perioperative reperfusion could aggravate myocardial injury in SPKT. Dex may be considered a way to reduce myocardial injury caused by inflammatory action by decreasing the release of inflammatory factors. Trial Registration Number: Chinese Clinical Trial Registry ID: ChiCTR2200060084.
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Affiliation(s)
- Aili Dong
- Tianjin First Center Hospital, Tianjin 300192, China
| | - Yajing Zhang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300193, China
| | - Shujun Lu
- Tianjin First Center Hospital, Tianjin 300192, China
| | - Wenli Yu
- Tianjin First Center Hospital, Tianjin 300192, China
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11
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Campsen J, Zimmerman MA. Pancreas transplantation following donation after circulatory death. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype. URO 2022. [DOI: 10.3390/uro2040026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Prior to year 2000, the majority of pancreas transplants (PTx) were performed as simultaneous pancreas-kidney transplants (SPKTs) in Caucasian adults with end stage renal failure secondary to type 1 diabetes mellitus (T1DM) who were middle-aged. In the new millennium, improving outcomes have led to expanded recipient selection that includes patients with a type 2 diabetes mellitus (T2DM) phenotype, which excessively affects minority populations. Methods: Using PubMed® to identify appropriate citations, we performed a literature review of PTx in minorities and in patients with a T2DM phenotype. Results: Mid-term outcomes with SPKT in patients with uremia and circulating C-peptide levels (T2DMphenotype) are comparable to those patients with T1DM although there may exist a selection bias in the former group. Excellent outcomes with SPKT suggests that the pathophysiology of T2DM is heterogeneous with elements consisting of both insulin deficiency and resistance related to beta-cell failure. As a result, increasing endogenous insulin (Cp) production following PTx may lead to freedom checking blood sugars or taking insulin, better metabolic counter-regulation, and improvements in quality of life and life expectancy compared to other available treatment options. Experience with solitary PTx for T2DM or in minorities is limited but largely mirrors the trends reported in SPKT. Conclusions: PTx is a viable treatment option in patients with pancreas endocrine failure who are selected appropriately regardless of diabetes type or recipient race. This review will summarize data that unconventional patient populations with insulin-requiring diabetes may gain value from PTx with an emphasis on contemporary experiences and appropriate selection in minorities in the new millennium.
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13
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Marques J, Pereira L, Messias A, Fonseca N, Cotovio P, Ferreira A, Nolasco F. The burden of coronary heart disease in simultaneous pancreas-kidney transplantation: coronary angiography as a diagnostic method for all? - a retrospective study. J Bras Nefrol 2022; 44:522-526. [PMID: 35258070 PMCID: PMC9838668 DOI: 10.1590/2175-8239-jbn-2021-0156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 12/13/2021] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus is associated with an increased risk of coronary artery disease, which is frequently asymptomatic. This risk increases significantly in those with nephropathy. In selected patients, simultaneous pancreas-kidney transplantation is the renal and pancreatic replacement therapy of choice, as it increases longevity and stabilizes diabetic complications. Despite essential, universal screening protocols are still controversial for coronary artery disease in this population. METHODS We retrospectively analysed 99 simultaneous pancreas-kidney recipients from our centre from 2011 to 2018 and selected 77 patients who underwent coronary angiography during the pre-transplant evaluation. Our aim was to identify potential risk factors associated with significant lesions on coronary angiography. RESULTS Almost half of our cohort of 77 candidates submitted to coronary angiography had coronary artery disease. Of these, nearly 30% underwent revascularization, although only one of them reported symptoms of myocardial ischemia. In a univariate analysis, the presence of smoking habits was the only risk factor for coronary artery disease. We also found that 20 or more years of type 1 diabetes mellitus was significantly associated with the presence of coronaropathy. DISCUSSION Selection of diabetic candidates with acceptable cardiac risk before simultaneous pancreas-kidney transplantation is imperative. Given the impact of a correct diagnosis and a low procedural risk, we defend the routine use of coronary angiography as the initial screening method for coronary artery disease in this population. Particularly care must be taken in evaluating asymptomatic patients with long-term type 1 diabetes mellitus and smokers.
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Affiliation(s)
- Joana Marques
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal
| | - Luísa Pereira
- Centro Hospitalar Universitário do Algarve, Serviço de Nefrologia,
Faro, Portugal
| | - Ana Messias
- Hospital Garcia de Orta, Serviço de Nefrologia, Almada,
Portugal
| | - Nuno Fonseca
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal
| | - Patrícia Cotovio
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal
| | - Aníbal Ferreira
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal.,Nova Medical School, Hospital Curry Cabral, Serviço de Nefrologia,
Lisboa, Portugal
| | - Fernando Nolasco
- Centro Hospitalar de Lisboa Central, Serviço de Nefrologia, Lisboa,
Portugal.,Nova Medical School, Hospital Curry Cabral, Serviço de Nefrologia,
Lisboa, Portugal
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14
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Montagud-Marrahi E, Amor AJ, Molina-Andujar A, Cucchiari D, Revuelta I, Esforzado N, Cofan F, Oppenheimer F, Torregrosa V, Casals J, Ferrer J, Esmatjes E, Ramírez-Bajo MJ, Musquera M, Bayes B, Campistol JM, Diekmann F, Ventura-Aguiar P. Impact of insulin therapy before donation on graft outcomes in pancreas transplantation: An analysis of the OPTN/UNOS database. Diabetes Res Clin Pract 2021; 182:109120. [PMID: 34742782 DOI: 10.1016/j.diabres.2021.109120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/27/2021] [Accepted: 11/01/2021] [Indexed: 11/20/2022]
Abstract
AIMS Information on the impact of insulin therapy before pancreas donation on pancreas outcomes is scarce. We aim to explore the influence of insulin therapy before donation on recipient and pancreas graft survival. METHODS Registry study including 12,841 pancreas recipients from the OPTN/UNOS registry performed between 2000 and 2017. Inverse probability of treatment weighting (IPTW) was used to account for covariate imbalance between recipients from a donor with and without insulin requirements. RESULTS A total of 7765 (60%) patients received a pancreas from a donor with insulin before donation (IBD). Pancreas graft survival (death-censored) was similar between recipients from IBD and non-IBD donors at 1, 5 and 10 years (89% vs 89%, 78% vs 79 and 69% vs 70%, respectively, P = 0.35). Recipients from IBD donors presented a similar 90-days pancreas graft survival. After IPTW weighting, IBD donors were neither associated with any post-transplant surgical complication (HR 1.11 [95% CI 0.98-1.24], P = 0.06), nor with risk for recipient death (HR 0.94 [95% CI 0.85-1.04], P = 0.26), nor pancreas graft failure (HR 1.06 [95% CI 0.98-1.16], P = 0.15). CONCLUSIONS Insulin therapy before donation in accepted pancreas donors was not associated, per se, with an impaired pancreas graft and patient survival.
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Affiliation(s)
- Enrique Montagud-Marrahi
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain; Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Spain
| | - Alicia Molina-Andujar
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain; Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - David Cucchiari
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain; Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - Ignacio Revuelta
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain; Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - Nuria Esforzado
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain
| | - Frederic Cofan
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain
| | - Federic Oppenheimer
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain
| | - Vicens Torregrosa
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain
| | - Joaquim Casals
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain
| | - Joana Ferrer
- Hepatobiliopancreatic and Liver Transplant Department, Hospital Clínic Barcelona, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic Barcelona, Spain
| | - Maria José Ramírez-Bajo
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | | | - Beatriu Bayes
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain
| | - Josep M Campistol
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain; Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain; Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain.
| | - Pedro Ventura-Aguiar
- Nephrology and Kidney Transplant Department, Hospital Clínic Barcelona, Spain; Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Fundació Clínic per a la Recerca Biomèdica (FCRB), Barcelona, Spain.
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15
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Callaghan CJ, Ibrahim M, Counter C, Casey J, Friend PJ, Watson CJE, Karydis N. Outcomes after simultaneous pancreas-kidney transplantation from donation after circulatory death donors: A UK registry analysis. Am J Transplant 2021; 21:3673-3683. [PMID: 33870619 DOI: 10.1111/ajt.16604] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/06/2021] [Accepted: 04/07/2021] [Indexed: 01/25/2023]
Abstract
There are concerns that simultaneous pancreas-kidney (SPK) transplants from donation after circulatory death (DCD) donors have a higher risk of graft failure than those from donation after brain death (DBD) donors. A UK registry analysis of SPK transplants between 2005 and 2018 was performed. Pancreas survivals of those receiving organs from DCD or DBD donors were compared. Multivariable analyses were used to adjust for baseline differences between the two groups and to identify factors associated with pancreas graft loss. A total of 2228 SPK transplants were implanted; 403 (18.1%) were from DCD donors. DCD donors were generally younger, slimmer, less likely to have stroke as a cause of death, with lower terminal creatinines and shorter pancreas cold ischemic times than DBD donors. Median (IQR) follow-up was 4.2 (1.6-8.1) years. On univariable analysis, there were no statistically significant differences in 5-year death-censored pancreas graft survival between the two donor types (79.5% versus 80.4%; p = .86). Multivariable analysis showed no statistically significant differences in 5-year pancreas graft loss between transplants from DCD (n = 343) and DBD (n = 1492) donors (hazard ratio 1.26, 95% CI 0.76-1.23; p = .12). The findings from this study support the increased use of SPK transplants from DCD donors.
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Affiliation(s)
- Chris J Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Maria Ibrahim
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, UK
| | - Claire Counter
- Statistics and Clinical Studies, National Health Service Blood and Transplant, Bristol, UK
| | - John Casey
- Edinburgh Transplant Centre, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Peter J Friend
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Christopher J E Watson
- Department of Surgery, University of Cambridge, and Cambridge NIHR Biomedical Research Centre, The NIHR Blood and Transplant Research Unit in Organ Donation and Transplantation, Cambridge, UK
| | - Nikolaos Karydis
- Department of Nephrology and Transplantation, Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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16
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Amor AJ, Casas A, Pané A, Ruiz S, Montagud-Marrahi E, Molina-Andújar A, Ruiz M, Mayordomo R, Musquera M, Ferrer-Fàbrega J, Fondevila C, Diekmann F, Ventura-Aguiar P, Esmatjes E. Weight gain following pancreas transplantation in type 1 diabetes is associated with a worse glycemic profile: A retrospective cohort study. Diabetes Res Clin Pract 2021; 179:109026. [PMID: 34454005 DOI: 10.1016/j.diabres.2021.109026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/23/2021] [Accepted: 08/23/2021] [Indexed: 01/22/2023]
Abstract
AIMS Evaluate the weight trajectories after pancreas transplantation (PT) and their relationships with pancreas graft outcomes in type 1 diabetes (T1D). METHODS Retrospective cohort study. T1D individuals who underwent PT were recruited (T1D-PT; n = 194) and divided into three groups according to transplantation date: 1999-2004 (n = 57), 2005-2009 (n = 79), 2010-2015 (n = 58). For weight comparisons, a random sample of T1D without renal impairment was also recruited during 2015 (n = 61; T1D-control). RESULTS The median follow-up for the T1D-PT group was 11.1 years. Despite significant weight loss at 6 months (65.7 ± 12.4 vs. 64.1 ± 11.4 Kg; p < 0.001), a stepped increase was seen thereafter (60 months: 68.0 ± 14.0 Kg; p < 0.001). Participants from the 2010-2015 period showed higher weight gain (p < 0.001), outweighing that observed in the T1D-control (60 months: +4.69 ± 8.49 vs. -0.97 ± 4.59 Kg; p = 0.003). Weight gain between 6 and 36 months was directly associated with fasting glucose and HbA1c at 36 months, and with HbA1c at 60 months (p < 0.05). However, in Cox-regression models adjusted for age, sex, and several recipient and PT-related variables, the third tertile of weight gain between 6 and 36 months showed a non-significant increase in the graft failure/dysfunction (HR 2.33 [0.75-7.27]). CONCLUSIONS Weight gain post-PT was associated with glucose-related biochemical markers of graft dysfunction, which needs confirmation in further studies.
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Affiliation(s)
- Antonio J Amor
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - Aida Casas
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Adriana Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sabina Ruiz
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Enrique Montagud-Marrahi
- Renal Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Alicia Molina-Andújar
- Renal Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Montserrat Ruiz
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Rosa Mayordomo
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Urology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Joana Ferrer-Fàbrega
- Hepatobiliopancreatic and Liver Transplant Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Constantino Fondevila
- Hepatobiliopancreatic and Liver Transplant Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fritz Diekmann
- Renal Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain; Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Red de Investigación Renal (REDINREN), Madrid, Spain
| | - Pedro Ventura-Aguiar
- Renal Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clínic de Barcelona, Barcelona, Spain; Laboratori Experimental de Nefrologia i Trasplantament (LENIT), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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17
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Cornateanu SM, O'Neill S, Dholakia S, Counter CJ, Sherif AE, Casey JJ, Friend P, Oniscu GC. Pancreas utilization rates in the UK - an 11-year analysis. Transpl Int 2021; 34:1306-1318. [PMID: 33794037 DOI: 10.1111/tri.13876] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 01/17/2023]
Abstract
Utilization of pancreases for transplantation remains inferior to that of other organs. Herein, we analysed UK pancreas discards to identify the reasons for the low utilization rates. Data on all pancreases offered first for solid organ transplantation between 1st January 2005 and 31st December 2015 were extracted from the UK Transplant Registry. The number of organs discarded, reasons and the time point of discard were analysed. A centre specific comparison was also undertaken. 7367 pancreases were offered first for solid organ transplantation. 35% were donors after circulatory death (DCD). 3668 (49.7%) organs were not retrieved. Of the 3699 pancreases retrieved, 38% were initially accepted but subsequently discarded. 2145 (29%) grafts offered were transplanted as simultaneous pancreas-kidney or solitary pancreas. 1177 (55%) were transplanted on the first offer whilst the remaining 968 were transplanted after a median of three offers. 52% DBD pancreases were accepted and transplanted on the first offer compared with 68% DCD grafts. There were significant differences in discard rates between centres (30-80% for DBD and 3-78% for DCD, P < 0.001). A significant number of solid pancreases are discarded. Better graft assessment at retrieval could minimize unnecessary organ travel and discards. Closer links with islet programmes may allow for better utilization of discarded grafts.
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Affiliation(s)
- Sorina M Cornateanu
- Scottish Pancreas Transplant Unit, Edinburgh Transplant Centre, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Stephen O'Neill
- Department of Transplant Surgery, Belfast City Hospital, Belfast, UK
| | | | | | - Ahmed E Sherif
- Scottish Pancreas Transplant Unit, Edinburgh Transplant Centre, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - John J Casey
- Scottish Pancreas Transplant Unit, Edinburgh Transplant Centre, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | | | - Gabriel C Oniscu
- Scottish Pancreas Transplant Unit, Edinburgh Transplant Centre, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
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18
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Impact of Recipient Age on Outcomes After Pancreas Transplantation. Transplant Proc 2021; 53:2046-2051. [PMID: 34020798 DOI: 10.1016/j.transproceed.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Few reports have provided the ages of pancreas transplant recipients. The aim of this study was to determine whether recipient age affects survival of pancreatic grafts after transplantation. METHODS We analyzed 73 patients who had undergone pancreas transplantation at our institution from August 2001 to March 2020 and assessed the effects of recipient age on pancreas graft survival within 5 years after pancreas transplantation. RESULTS The cutoff value for recipient age established by receiver operating characteristic curve was 35 years. The pancreas graft survival rate of recipients aged 35 years or younger (1, 3, and 5 years: 72.9%, 41.7%, and 41.7%, respectively) was significantly lower than that of recipients aged over 35 years (1, 3, and 5 years: 93.2%, 88.4%, and 88.4%, respectively). Multivariate Cox hazard regression analysis showed that recipient age 35 years or younger (hazard ratio = 3.60; 95% confidence interval, 1.04-12.50; P = .044) and solitary pancreas transplantation (hazard ratio = 10.72; 95% confidence interval, 2.72-42.28; P < .001) were significant risk factors for pancreas graft loss within 5 years. CONCLUSION Our data suggest that younger recipient age is a risk factor for pancreas graft loss after transplantation.
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19
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Leiberman D, Sharma V, Siddagangaiah V, Lake E, van Dellen D, Dhanda R, Augustine T, Seriki D, Singh R. Radiological initial treatment of vascular catastrophes in pancreas transplantation: Review of current literature. Transplant Rev (Orlando) 2021; 35:100624. [PMID: 33906064 DOI: 10.1016/j.trre.2021.100624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 04/06/2021] [Accepted: 04/10/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Arterio-enteric fistula (AEF) is a rare but potentially devastating complication of solid organ pancreatic transplantation. Traditional management has been to remove the pancreas-duodenum allograft and control the vascular defect. Interventional radiological (IR) techniques present a new method of managing AEF related haemorrhage without re-operation and the potential to preserve graft function. This paper examines the available literature to assess efficacy and safety of this novel approach. METHODS Aggregate results tables were constructed from 28 cases identified in the English language literature where IR was used in the management of AEF following pancreas transplantation. Outcomes recorded were death, re-bleeding, surgical intervention required and post intervention graft function. These were analysed with respect to technical factors and graft function at time of presentation. RESULTS 28 cases of AEF managed by IR methods were identified. Mortality was high at 17.9%. 78.6% of all AEFs were present in failed pancreas allografts. Median time from transplant to bleeding event was 29 months. There was a trend of bleeding event occurring within 12 months of allograft failure or rejection. Of the AEFs present in functioning grafts, graft salvage rate was 33% from available data. Coil embolization or use of haemostatic compressed sponge as primary intervention was associated with a higher rate of re-bleeding and death versus arterial stenting. Arterial stenting resulted in a higher rate of distal ischaemia requiring surgical re-vascularisation. All deaths occurred in patients who did not have a transplant pancreatectomy as part of their definitive treatment. CONCLUSION IR can be an effective way to manage bleeding in the context of AEF associated with pancreas transplantation. If patient condition allows, it should be the first-choice intervention to manage AEF associated bleeding. Use of arterial stenting is more effective in controlling and preventing further bleeding. In a non-functioning graft, transplant pancreatectomy should be strongly considered, possibly in conjunction with or following arterial stenting.
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Affiliation(s)
- David Leiberman
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK.
| | - Videha Sharma
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester, Faculty of Biology, Medicine and Health, Division of Informatics, Imaging and Data Science, Manchester, Greater Manchester M13 9PT, UK
| | - Vishwanath Siddagangaiah
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
| | - Edward Lake
- Manchester University Hospitals NHS Foundation Trust, Department of Radiology, Manchester Royal Infirmary, Manchester, Greater Manchester M13 9WL, UK
| | - David van Dellen
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester, Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester M13 9PT, UK
| | - Raman Dhanda
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
| | - Titus Augustine
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK; University of Manchester, Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, Manchester, Greater Manchester M13 9PT, UK
| | - Dare Seriki
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
| | - Rajinder Singh
- Manchester University Hospitals NHS Foundation Trust, Department of Renal and Pancreatic Transplantation, Manchester Academic Health Science Centre, Manchester, Greater Manchester, M13 9WL, UK
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Gurung K, Alejo J, Rogers J, Farney AC, Orlando G, Jay C, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Doares W, Kaczmorski S, Gautreaux MD, Stratta RJ. Recipient age and outcomes following simultaneous pancreas-kidney transplantation in the new millennium: Single-center experience and review of the literature. Clin Transplant 2021; 35:e14302. [PMID: 33783874 DOI: 10.1111/ctr.14302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 12/30/2022]
Abstract
The influence of recipient age on outcomes following simultaneous pancreas-kidney transplantation (SPKT) in the modern era is uncertain. METHODS We retrospectively studied 255 patients undergoing SPKT from 11/01 to 8/20. Recipients were stratified according to age group: age <30 years (n = 16); age 30-39 years (n = 91); age 40-49 years (n = 86) and age ≥50 years (n = 62 [24.3%], including 9 patients ≥60 years of age). RESULTS Three-month and one-year outcomes were comparable. The eight-year patient survival rate was lowest in the oldest age group (47.6% vs 78% in the 3 younger groups combined, p < .001). However, eight-year kidney and pancreas graft survival rates were comparable in the youngest and oldest age groups combined (36.5% and 32.7%, respectively), but inferior to those in the middle 2 groups combined (62% and 50%, respectively, both p < .05). Death-censored kidney and pancreas graft survival rates increased from youngest to oldest recipient age category because of a higher incidence of death with functioning grafts (22.6% in oldest group compared to 8.3% in the 3 younger groups combined, p = .005). CONCLUSIONS Recipient age did not appear to significantly influence early outcomes following SPKT. Late outcomes are similar in younger and older recipients, but inferior to the middle 2 age groups.
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Affiliation(s)
- Komal Gurung
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Jennifer Alejo
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Jeffrey Rogers
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Alan C Farney
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Giuseppe Orlando
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Colleen Jay
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Amber Reeves-Daniel
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Alejandra Mena-Gutierrez
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Natalia Sakhovskaya
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - William Doares
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Scott Kaczmorski
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Michael D Gautreaux
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Robert J Stratta
- Department of Surgery, Section of Transplantation, Wake Forest Baptist Health, Winston-Salem, NC, USA
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Impact of Simultaneous Pancreas-kidney Transplantation on Cardiovascular Risk in Patients With Diabetes. Transplantation 2021; 106:158-166. [PMID: 33660656 DOI: 10.1097/tp.0000000000003710] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND cardiovascular disease is the major cause of death in patients with type 1 Diabetes. Of the available risk predictors for this population, the Steno Type 1 Risk Engine (STENO T1) is the only one which includes kidney function as a risk factor, which is a well described independent risk factor for cardiovascular disease. METHODS we explore how SPKT modifies the predicted cardiovascular risk by the STENO T1 through a retrospective study including recipients of a first SPKT between 2000 and 2016. RESULTS 268 SPKT recipients with a mean age of 40 years old and a median follow-up of 10 years were included. Prior to transplantation, the expected incidence of Cardiovascular Events (CVE) at 5 and 10 years according to STENO T1 would have been 31% and 50%, respectively, contrasting with an actual incidence of 9.3% and 16% for the same timepoints, respectively (P < 0.05). These differences were attenuated when STENO T1 was recalculated assuming 12th month glomerular filtration rate (at 5 and 10 years predicted CVE incidence was of 10.5% and 19.4%, respectively). Early pancreas graft failure (HR 3.00 [95% CI 1.14 - 7.88]; P = 0.02) was an independent risk factor for post-SPKT CVE, alongside with kidney graft failure (HR 2.90 [95% CI 1.53 - 5.48]; P = 0.001), and diabetes duration (HR 1.04 [95% CI 1.00-1.09], P = 0.04). CONCLUSIONS SPKT decreases in more two-thirds the predicted cardiovascular risk by the STENO T1. A functioning pancreas graft further reduces CVE risk, independently of kidney graft function.
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22
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Scheuermann U, Rademacher S, Jahn N, Sucher E, Seehofer D, Sucher R, Hau HM. Impact of pre-transplant dialysis modality on the outcome and health-related quality of life of patients after simultaneous pancreas-kidney transplantation. Health Qual Life Outcomes 2020; 18:303. [PMID: 32912255 PMCID: PMC7488156 DOI: 10.1186/s12955-020-01545-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 08/26/2020] [Indexed: 01/08/2023] Open
Abstract
Background Simultaneous pancreas-kidney transplantation (SPKT) profoundly improves the health-related quality of life (HRQoL) of recipients. However, the influence of the pre-transplant dialysis modality on the success of the SPKT and post-transplant HRQoL remains unknown. Methods We analyzed the surgical outcome, long-term survival, as well as HRQoL of 83 SPKTs that were performed in our hospital between 2000 and 2016. Prior to transplant, 64 patients received hemodialysis (HD) and nineteen patients received peritoneal dialysis (PD). Physical and mental quality of life results from eight basic scales and the physical and mental component summaries (PCS and MCS) were measured using the Short Form 36 (SF-36) survey. Results Peri- and postoperative complications, as well as patient and graft survival were similar between the two groups. Both groups showed an improvement of HRQoL in all SF-36 domains after transplantation. Compared with patients who received HD before transplantation, PD patients showed significantly better results in four of the eight SF-36 domains: physical functioning (mean difference HD - PD: − 12.4 ± 4.9, P = < 0.01), bodily pain (− 14.2 ± 6.3, P < 0.01), general health (− 6.3 ± 2.8, P = 0.04), vitality (− 6.8 ± 2.6, P = 0.04), and PCS (− 5.2 ± 1.5, P < 0.01) after SPKT. In the overall study population, graft loss was associated with significant worsening of the HRQoL in all physical components (each P < 0.01). Conclusions The results of this analysis show that pre-transplant dialysis modality has no influence on the outcome and survival rate after SPKT. Regarding HRQoL, patients receiving PD prior to SPKT seem to have a slight advantage compared with patients with HD before transplantation.
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Affiliation(s)
- Uwe Scheuermann
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Nora Jahn
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Gastroenterology, University Hospital of Leipzig, Leipzig, Germany
| | - Daniel Seehofer
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany. .,Department of Visceral, Thoracic and Vascular Surgery, University Hospital and Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany.
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Impact of Functional Status on Outcomes of Simultaneous Pancreas-kidney Transplantation: Risks and Opportunities for Patient Benefit. Transplant Direct 2020; 6:e599. [PMID: 32903964 PMCID: PMC7447442 DOI: 10.1097/txd.0000000000001043] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/27/2020] [Indexed: 01/16/2023] Open
Abstract
Background. The impact of functional status on survival among simultaneous pancreas-kidney transplant (SPKT) candidates and recipients is not well described. Methods. We examined national Scientific Registry of Transplant Recipients (SRTR) data for patients listed for SPKT in the United States (2006–2019). Functional status was categorized by center-reported Karnofsky Performance Score (KPS). We used Cox regression to quantify associations of KPS at listing and transplant with subsequent patient survival, adjusted for baseline patient and transplant factors (adjusted hazard ratio, 95% LCLaHR95%UCL). We also explored time-dependent associations of SPKT with survival risk after listing compared with continued waiting in each functional status group. Results. KPS distributions among candidates (N = 16 822) and recipients (N = 10 316), respectively, were normal (KPS 80–100), 62.0% and 57.8%; capable of self-care (KPS 70), 23.5% and 24.7%; requires assistance (KPS 50–60), 12.4% and 14.2%; and disabled (KPS 10–40), 2.1% and 3.3%. There was a graded increase in mortality after listing and after transplant with lower functional levels. Compared with normal functioning, mortality after SPKT rose progressively for patients capable of self-care (aHR, 1.001.181.41), requiring assistance (aHR, 1.061.311.60), and disabled (aHR, 1.101.552.19). In time-dependent regression, compared with waiting, SPKT was associated with 2-fold mortality risk within 30 days of transplant. However, beyond 30 days, SPKT was associated with reduced mortality, from 52% for disabled patients (aHR, 0.260.480.88) to 70% for patients with normal functioning (aHR, 0.260.300.34). Conclusions. While lower functional status is associated with increased mortality risk among SPKT candidates and recipients, SPKT can provide long-term survival benefit across functional status levels in those selected for transplant.
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Abstract
PURPOSE OF REVIEW Despite significant improvement in pancreas allograft survival, rejection continues to be a major clinical problem. This review will focus on emerging literature related to the impact of pretransplant and de-novo DSA (dnDSA) in pancreas transplant recipients, and the diagnosis and treatment of T-cell-medicated rejection (TCMR) and antibody-mediated rejection (ABMR) in this complex group of patients. RECENT FINDINGS Recent data suggest that pretransplant DSA and the emergence of dnDSA in pancreas transplant recipients are both associated with increased risk of ABMR. The pancreas allograft biopsy is essential for the specific diagnosis of TCMR and/or ABMR, distinguish rejection from other causes of graft dysfunction, and to guide-targeted therapy. This distinction is important especially in the setting of solitary pancreas transplants but also in simultaneous pancreas-kidney transplants where solid evidence has now emerged demonstrating discordant biopsy findings. Treatment of rejection in a functioning pancreas can prolong allograft survival. SUMMARY The accurate and timely diagnosis of active alloimmune destruction in pancreas transplant recipients is paramount to preserving graft function in the long term. This review will discuss new, rapidly evolving information that is valuable for the physician caring for these patients to achieve optimal immunological outcomes.
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More Than 25 Years of Pancreas Graft Survival After Simultaneous Pancreas and Kidney Transplantation: Experience From the World's Largest Series of Long-term Survivors. Transplantation 2020; 104:1287-1293. [PMID: 31568218 DOI: 10.1097/tp.0000000000002960] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Ruiz S, Amor AJ, Pané A, Molina-Andujar A, Montagud-Marrahi E, Ventura-Aguiar P, Ferrer-Fàbrega J, Esmatjes E. Cardiovascular risk factors and cardiovascular disease in patients with type 1 diabetes and end-stage renal disease candidates for kidney-pancreas transplantation: Trends from 1999 to 2017. Diabetes Res Clin Pract 2020; 163:108135. [PMID: 32259612 DOI: 10.1016/j.diabres.2020.108135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/21/2020] [Accepted: 03/26/2020] [Indexed: 02/06/2023]
Abstract
AIMS To evaluate the changes in cardiovascular risk factors (CVRFs) and cardiovascular disease (CVD) in patients with type 1 diabetes (T1D) and end-stage renal disease (ESRD) who were candidates for kidney-pancreas transplantation (KPTx) from 1999 to 2017. METHODS Patients with T1D referred for KPTx evaluation were included. The cohort was divided into five groups according to the year of evaluation (1999-2002, 2003-2006, 2007-2010, 2011-2014 and 2015-2017). The control of CVRFs and the prevalence of prior CVD were evaluated. RESULTS We evaluated 360 patients (64.4% men, age 38.9 ± 7.1 years). LDL-cholesterol <100 mg/dl increased from 22.7% to 76.9% (1999-2002 vs. 2015-2017; p < 0.001), as did the use of statins (from 24.7% to 74.5%; p < 0.001). Systolic blood pressure decreased from 138.8 ± 27.6 to 125.1 ± 27.9 mmHg (p = 0.001) and current smokers from 48% to 25% (p = 0.018). Intensive insulin treatment increased from 34.4% to 93.6% (p < 0.001). Diabetes duration before the initiation of renal replacement therapy increased from 23 ± 5.5 to 26.9 ± 8.9 years (p = 0.001). Overall, 30.3% had previous CVD, without significant changes over time (p = 0.699), albeit patients were older and had longer diabetes duration. CONCLUSIONS Patients with T1D and ESRD referred for KPTx have better control of CVRFs over time, which might lead to a decrease in cardiovascular events.
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Affiliation(s)
- Sabina Ruiz
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain.
| | - Antonio Jesús Amor
- Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Spain; Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Adriana Pané
- Endocrinology and Nutrition Department, Hospital Clínic de Barcelona, Spain.
| | - Alicia Molina-Andujar
- Renal Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clínic de Barcelona, Spain.
| | - Enrique Montagud-Marrahi
- Renal Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clínic de Barcelona, Spain.
| | - Pedro Ventura-Aguiar
- Renal Transplant Unit, Nephrology and Kidney Transplantation Department, Hospital Clínic de Barcelona, Spain; Laboratori Experimental de Nefrologia i transplantament (LENIT), CRB CELLEX, Fundació Clínic, IDIBAPS, Barcelona, Spain.
| | - Joana Ferrer-Fàbrega
- HepatoBilioPancreatic Surgery, and Liver and Pancreatic Transplantation Unit, Department of Surgery, Hospital Clínic de Barcelona, Spain.
| | - Enric Esmatjes
- Diabetes Unit, Endocrinology and Nutrition Department, Institut d'Investigacions Biomèdiques August Pi Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
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Kulu Y, Khajeh E, Ghamarnejad O, Nikdad M, Sabagh M, Ali-Hasan-Al-Saegh S, Nadalin S, Quante M, Pisarski P, Jänigen B, Reißfelder C, Mieth M, Morath C, Goeppert B, Schirmacher P, Strobel O, Hackert T, Zeier M, Springel R, Schleicher C, Büchler MW, Mehrabi A. Expanding pancreas donor pool by evaluation of unallocated organs after brain death: Study protocol clinical trial (SPIRIT Compliant). Medicine (Baltimore) 2020; 99:e19335. [PMID: 32150070 PMCID: PMC7478640 DOI: 10.1097/md.0000000000019335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Pancreas graft quality directly affects morbidity and mortality rates after pancreas transplantation (PTx). The criteria for pancreas graft allocation are restricted, which has decreased the number of available organs. Suitable pancreatic allografts are selected based on donor demographics, medical history, and the transplant surgeon's assessment of organ quality during procurement. Quality is assessed based on macroscopic appearance, which is biased by individual experience and personal skills. Therefore, we aim to assess the histopathological quality of unallocated pancreas organs to determine how many unallocated organs are potentially of suitable quality for PTx. METHODS AND ANALYSIS This is a multicenter cross-sectional explorative study. The demographic data and medical history of donor and cause of rejection of the allocation of graft will be recorded. Organs of included donors will be explanted and macroscopic features such as weight, color, size, and stiffness will be recorded by 2 independent transplant surgeons. A tissue sample of the organ will be fixed for further microscopic assessments. Histopathologic assessments will be performed as soon as a biopsy can be obtained. We will evaluate up to 100 pancreata in this study. RESULT This study will evaluate the histopathological quality of unallocated pancreas organs from brain-dead donors to determine how many of these unallocated organs were potentially suitable for transplantation based on a histopathologic evaluation of organ quality. CONCLUSION The comprehensive findings of this study could help to increase the pancreas graft pool, overcome organ shortage, reduce the waiting time, and also increase the number of PTx in the future. Registration number: ClinicalTrials.gov: NCT04127266.
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Affiliation(s)
- Yakup Kulu
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Elias Khajeh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Omid Ghamarnejad
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Mohammadsadegh Nikdad
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Mohammadsadegh Sabagh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Sadeq Ali-Hasan-Al-Saegh
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University Hospital Tuebingen, Tuebingen
| | - Markus Quante
- Department of General, Visceral, and Transplant Surgery, University Hospital Tuebingen, Tuebingen
| | - Przemyslaw Pisarski
- Transplantation Center, Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Bernd Jänigen
- Transplantation Center, Department of General and Visceral Surgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg
| | - Christoph Reißfelder
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim
| | - Markus Mieth
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Christian Morath
- Department of Nephrology, Heidelberg University Hospital, Heidelberg
| | | | | | - Oliver Strobel
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Thilo Hackert
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Martin Zeier
- Department of Nephrology, Heidelberg University Hospital, Heidelberg
| | | | | | - Markus W. Büchler
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
| | - Arianeb Mehrabi
- Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg
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28
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Mensink JW, de Vries KM, Huurman VAL, Pol RA, Alwayn IPJ, Braat AE. Risk analysis of extended pancreas donor selection criteria. Pancreatology 2019; 19:994-999. [PMID: 31495709 DOI: 10.1016/j.pan.2019.08.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/04/2019] [Accepted: 08/25/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The success of pancreas transplantation, in combination with a stable number of available allografts has resulted in an increasing waiting list. This study investigated donor potential by expanding age and Body Mass Index (BMI) criteria. METHODS All reported donors in the Netherlands between 2013 and 2017 were analysed. Risk assessment of extended criteria donors was done by in-depth analysis of donor reports and calculation of the Pancreas Donor Risk Index (PDRI). The PDRI of these extended criteria donors was compared to standard criteria donors to evaluate the increased risk on graft failure. RESULTS A total of 1273 donors were reported. Of these donors, 405 donors were reported as pancreas donor, of which 93 (23%) pancreata were transplanted. Extending age criterion with 5 years could result in additional 40 Donation after Brain Death donors and 37 Donation after Circulatory Death donors reported. In 24 (31%) extended age criteria donors the PDRI was below the upper limit of currently transplanted pancreata. Extending BMI criteria to 35 kg/m2 could result in an additional 19 (6%) donors reported. CONCLUSIONS Extending BMI criteria could result in a slight increase of reported donors. Extending age criteria increased significantly the number of reported donors. In 24 (31%) of the older donors the PDRI showed a reduced risk compared to currently transplanted pancreata. This study suggest that, if other risk factors are absent, pancreata of extended age and/or BMI criteria donors should be considered for transplantation.
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Affiliation(s)
- Jacobus W Mensink
- Department of Transplant Surgery, LUMC, Leiden University, the Netherlands; Dutch Transplant Foundation, Leiden, the Netherlands.
| | | | | | - Robert A Pol
- Department of Transplant Surgery, UMCG, Groningen University, the Netherlands
| | - Ian P J Alwayn
- Department of Transplant Surgery, LUMC, Leiden University, the Netherlands
| | - Andries E Braat
- Department of Transplant Surgery, LUMC, Leiden University, the Netherlands
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29
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Rohan VS, McGillicuddy JW, Taber DJ, Nadig SN, Baliga PK, Bratton CF. Long‐standing diabetes mellitus and pancreas transplantation: An avenue to increase utilization of an ideal treatment modality. Clin Transplant 2019; 33:e13695. [DOI: 10.1111/ctr.13695] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 07/03/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Vinayak S. Rohan
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - John W. McGillicuddy
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - David J. Taber
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Satish N. Nadig
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
| | - Prabhakar K. Baliga
- Division of Transplant Surgery Department of Surgery Medical University of South Carolina Charleston SC USA
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30
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Yiannoullou P, Summers A, Goh SC, Fullwood C, Khambalia H, Moinuddin Z, Shapey IM, Naish J, Miller C, Augustine T, Rutter MK, van Dellen D. Major Adverse Cardiovascular Events Following Simultaneous Pancreas and Kidney Transplantation in the United Kingdom. Diabetes Care 2019; 42:665-673. [PMID: 30765431 DOI: 10.2337/dc18-2111] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/14/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE People with type 1 diabetes and kidney failure have an increased risk for major adverse cardiovascular events (MACE). Simultaneous pancreas and kidney transplantation (SPKT) improves survival, but the long-term risk for MACE is uncertain. RESEARCH DESIGN AND METHODS We assessed the frequency and risk factors for MACE (defined as fatal cardiovascular disease and nonfatal myocardial infarction or stroke) and related nonfatal MACE to allograft failure in SPKT recipients with type 1 diabetes who underwent transplantation between 2001 and 2015 in the U.K. In a subgroup, we related a pretransplant cardiovascular risk score to MACE. RESULTS During 5 years of follow-up, 133 of 1,699 SPKT recipients (7.8%) experienced a MACE. In covariate-adjusted models, age (hazard ratio 1.04 per year [95% CI 1.01-1.07]), prior myocardial infarction (2.6 [1.3-5.0]), stroke (2.3 [1.2-4.7]), amputation (2.0 [1.02-3.7]), donor history of hypertension (1.8 [1.05-3.2]), and waiting time (1.02 per month [1.0-1.04]) were significant predictors. Nonfatal MACE predicted subsequent allograft failure (renal 1.6 [1.06-2.6]; pancreas 1.7 [1.09-2.6]). In the subgroup, the pretransplant cardiovascular risk score predicted MACE (1.04 per 1% increment [1.02-1.06]). CONCLUSIONS We report a high rate of MACE in SPKT recipients. There are a number of variables that predict MACE, while nonfatal MACE increase the risk of subsequent allograft failure. It may be beneficial that organs from hypertensive donors are matched to recipients with lower cardiovascular risk. Pretransplant cardiovascular risk scoring may help to identify patients who would benefit from risk factor optimization or alternative transplant therapies and warrants validation nationally.
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Affiliation(s)
- Petros Yiannoullou
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, U.K. .,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Angela Summers
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, U.K.,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Shu C Goh
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Catherine Fullwood
- Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Research and Innovation, Manchester University NHS Foundation Trust, Manchester, U.K
| | - Hussein Khambalia
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, U.K.,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Zia Moinuddin
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, U.K.,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Iestyn M Shapey
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, U.K.,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Josephine Naish
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.,Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K
| | - Christopher Miller
- Division of Cardiovascular Sciences, School of Medical Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.,Wellcome Centre for Cell-Matrix Research, Division of Cell-Matrix Biology and Regenerative Medicine, School of Biology, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, U.K.,North West Heart Centre, Manchester University NHS Foundation Trust, Manchester, U.K
| | - Titus Augustine
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, U.K.,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K.,Manchester Diabetes Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, U.K
| | - David van Dellen
- Department of Renal and Pancreatic Transplantation, Manchester University NHS Foundation Trust, Manchester, U.K.,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, U.K
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Karakose E, Ackeifi C, Wang P, Stewart AF. Advances in drug discovery for human beta cell regeneration. Diabetologia 2018; 61:1693-1699. [PMID: 29770834 PMCID: PMC6239977 DOI: 10.1007/s00125-018-4639-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 04/05/2018] [Indexed: 12/15/2022]
Abstract
The numbers of insulin-secreting pancreatic beta cells are reduced in people with type 1 and type 2 diabetes. Driving beta cell regeneration in the pancreases of people with diabetes would be an attractive approach to reversing diabetes. While adult human beta cells have long been believed to be terminally differentiated and, therefore, irreversibly quiescent, it has become clear over recent years that this is not true. More specifically, both candidate and unbiased high-throughput screen approaches have revealed several classes of molecules that are clearly able to induce human beta cell proliferation. Here, we review recent approaches and accomplishments in human beta cell regenerative drug discovery. We also list the challenges that this rapidly moving field must confront to translate beta cell regenerative therapy from the laboratory to the clinic.
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Affiliation(s)
- Esra Karakose
- The Diabetes, Obesity and Metabolism Institute, The Icahn School of Medicine at Mount Sinai, Atran 5, Box 1152, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Courtney Ackeifi
- The Diabetes, Obesity and Metabolism Institute, The Icahn School of Medicine at Mount Sinai, Atran 5, Box 1152, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Peng Wang
- The Diabetes, Obesity and Metabolism Institute, The Icahn School of Medicine at Mount Sinai, Atran 5, Box 1152, 1 Gustave L. Levy Place, New York, NY, 10029, USA
| | - Andrew F Stewart
- The Diabetes, Obesity and Metabolism Institute, The Icahn School of Medicine at Mount Sinai, Atran 5, Box 1152, 1 Gustave L. Levy Place, New York, NY, 10029, USA.
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Nagaraju S, Mangus RS, Powelson JA, Fridell JA. Pancreas transplantation using compatible but non-identical ABO blood group donors. Clin Transplant 2018; 32:e13284. [PMID: 29774602 DOI: 10.1111/ctr.13284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are limited data on the outcomes of pancreas transplants using ABO non-identical but compatible (NIC) donors. METHODS A review of all pancreas transplants from a single institution from 01/2003 to 07/2016 (n = 606) revealed 41 recipients of a NIC donor pancreas which were matched for age, race, gender, year, and type of transplant with 41 ABO identical cases. Groups were compared for allograft survival, incidence of acute cellular rejection (ACR), length of hospital stay, 3-month readmissions and transfusion requirements. Serum haptoglobin and lactate dehydrogenase were used to identify hemolysis in patients requiring repeated transfusions without overt blood loss. RESULTS The 1-year graft survival was 100% and 88% in the study and control groups. In the study group, 6/41(14%) developed hemolysis, all of which were ABO O into A. All responded to donor blood type specific transfusions. DISCUSSION There are limited data on outcomes of solid organ transplant using NIC donors with almost none specifically addressing pancreas transplantation. In this study, graft survival was similar but 14% developed hemolysis, which was transient and treated with transfusion of donor blood type specific blood. CONCLUSION Non-identical but compatible pancreas transplants have similar graft survival compared to ABO identical. Hemolysis may occur so some caution is required.
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Affiliation(s)
- Santosh Nagaraju
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Richard S Mangus
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - John A Powelson
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Jonathan A Fridell
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
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Techniques of pancreas graft salvage/indications for allograft pancreatectomy. Curr Opin Organ Transplant 2017; 21:405-11. [PMID: 27058314 DOI: 10.1097/mot.0000000000000318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Despite improvements in pancreas allograft outcome, graft complications remain a significant cause of morbidity and mortality. This review analyses the issues involved in the management of conditions that may require graft pancreatectomy, including the indications and techniques for graft salvage. RECENT FINDINGS With early recognition of graft complications, liberal use of radiological interventions, improved infection control, access to critical care and innovative surgical techniques, graft salvage is now feasible in many circumstances where graft pancreatectomy would previously have been necessary. SUMMARY The outcome of pancreas transplantation continues to improve with advances in the management of graft-threatening complications.
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Association between the pancreas transplantation and survival of patients with diabetes: A single center experience. PLoS One 2017; 12:e0186827. [PMID: 29095903 PMCID: PMC5667822 DOI: 10.1371/journal.pone.0186827] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 10/01/2017] [Indexed: 12/15/2022] Open
Abstract
Pancreas transplantation is considered a therapeutic option for patients with complicated diabetes mellitus. In this study, we compared survival rate between patients on the waiting list for pancreas transplant alone(PTA), simultaneous pancreas–kidney(SPK) transplant, and pancreas after kidney(PAK) transplant and transplant recipients. A total of 503 patients (PTA:n = 116; SPK:n = 303; PAK:n = 84) and 280 PT recipients (PTA:n = 89; SPK:n = 155; PAK:n = 36) were retrospectively analyzed at our center between February 2000 and December 2015; 11.9%(60/503) of the patients on the waiting list and 4.3%(12/280) of the PT recipients died. The overall survival rate was higher in the waiting list group for the first year (99.3% vs. 97.8%), after which it was significantly higher in PT group (p = 0.039). The overall relative risk of all-cause mortality for transplant recipients was 2.145(p = 0.285) for PTA, 0.688(p = 0.735) for PAK, however,0.361 (p = 0.012) for SPK compared with that for the waiting list patients. SPK transplant recipients had considerable higher survival benefits, despite the relatively long waiting period, especially after 1 year. In addition, PTA and PAK can also be considered as a treatment option as patient survival was not poor.
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Jiménez-Romero C, Marcacuzco Quinto A, Manrique Municio A, Justo Alonso I, Calvo Pulido J, Cambra Molero F, Caso Maestro Ó, García-Sesma Á, Moreno González E. Simultaneous pancreas-kidney transplantation. Experience of the Doce de Octubre Hospital. Cir Esp 2017; 96:25-34. [PMID: 29089105 DOI: 10.1016/j.ciresp.2017.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/20/2017] [Accepted: 09/21/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Simultaneous pancreas-kidney transplantation (SPKT) constitutes the therapy of choice for diabetes type1 or type2 associated with end-stage renal disease, because is the only proven method to restore normo-glicemic control in the diabetic patient. METHODS Retrospective and descriptive study of a series of 175 patients who underwent SPKT from March 1995 to April 2016. We analyze donor and recipient characteristics, perioperative variables and immunosuppression, post-transplant morbi-mortality, patient and graft survival, and risk factors related with patient and graft survival. RESULTS Median age of the donors was 28years and mean age of recipients was 38.8±7.3years, being 103 males and 72 females. Enteric drainage of the exocrine pancreas was performed in 113 patients and bladder drainage in 62. Regarding post-transplant complications, the overall rate of infections was 70.3%; graft pancreatitis 26.3%; intraabdominal bleeding 17.7%; graft thrombosis 12.6%; and overall pancreas graft rejection 10.9%. The causes of mortality were mainly cardiovascular and infectious complications. Patient survival at 1, 3 and 5-year were 95.4%, 93% and 92.4%, respectively, and pancreas graft survival at 1, 3 and 5-year were 81.6%, 77.9% y 72.3%, respectively. CONCLUSIONS In our 20-year experience of simultaneous pancreas-kidney transplantation, the morbidity rate, and 5-year patient and pancreas graft survivals were similar to those previously reported from the international pancreas transplant registries.
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Affiliation(s)
- Carlos Jiménez-Romero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España.
| | - Alberto Marcacuzco Quinto
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Alejandro Manrique Municio
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Iago Justo Alonso
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Jorge Calvo Pulido
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Félix Cambra Molero
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Óscar Caso Maestro
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Álvaro García-Sesma
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
| | - Enrique Moreno González
- Unidad de Cirugía Hepato-Bilio-Pancreática y Trasplante de Órganos Abdominales, Departamento de Cirugía, Hospital Universitario Doce de Octubre, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, España
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Moinuddin I, Yaqub MS, Taber T, Powelson J, Fridell J, Sharfuddin A. Isolated pancreas rejections do not have an adverse impact on kidney graft survival whereas kidney rejections are associated with adverse pancreas graft survival in simultaneous pancreas kidney transplantation. J Nephrol 2017; 31:307-315. [DOI: 10.1007/s40620-017-0438-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 09/06/2017] [Indexed: 12/17/2022]
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Al-Adra D, McGilvray I, Goldaracena N, Spetzler V, Laurence J, Norgate A, Marquez M, Greig P, Sapisochin G, Schiff J, Singh S, Selzner M, Cattral M. Preserving the Pancreas Graft: Outcomes of Surgical Repair of Duodenal Leaks in Enterically Drained Pancreas Allografts. Transplant Direct 2017; 3:e179. [PMID: 28706982 PMCID: PMC5498020 DOI: 10.1097/txd.0000000000000698] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 04/16/2017] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Duodenal leak remains a major cause of morbidity and graft loss in pancreas transplant recipients. The role and efficacy of surgical and image-guided interventions to salvage enterically drained grafts with a duodenal leak has yet to be defined. METHODS We investigated the incidence, treatment, and outcome of duodenal leak in 426 pancreas transplantation recipients from 2000 to 2015. RESULTS Duodenal leak developed in 33 (7.8%) recipients after a median follow-up of 5.3 (range, 0.5-15.2) years. Most leaks occurred during the first year (n = 22; 67%), and most were located near the proximal and distal duodenal staple line. Graft pancreatectomy was performed in 8 patients as primary therapy because of unfavorable local and/or systemic conditions. Salvage was attempted in 25 patients using percutaneous drainage (n = 4), surgical drainage (n = 4), or surgical repair (n = 17). Percutaneous or surgical drainage failed to control the leak in 7 of these 8 patients, and all 7 ultimately required graft pancreatectomy for persistent leak and sepsis. Surgical repair salvaged 14 grafts, and 13 grafts continue to function after a median follow-up of 2.9 (range, 1.1-6.3) years after repair. CONCLUSIONS Our study shows that in selected patients a duodenal leak can be repaired successfully and safely in enterically drained grafts.
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Affiliation(s)
- David Al-Adra
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ian McGilvray
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Nicolas Goldaracena
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vinzent Spetzler
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jerome Laurence
- Royal Prince Alfred Institute of Academic Surgery, University of Sydney, Sydney, Australia
| | - Andrea Norgate
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Max Marquez
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Paul Greig
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gonzalo Sapisochin
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jeffrey Schiff
- Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Sunita Singh
- Department of Medicine, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Markus Selzner
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Mark Cattral
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Virtual HLA Crossmatching as a Means to Safely Expedite Transplantation of Imported Pancreata. Transplantation 2017; 100:1103-10. [PMID: 26950720 DOI: 10.1097/tp.0000000000001125] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Imported pancreata accumulate cold ischemia time (CIT), limiting utilization and worsening outcomes. Flow cytometric crossmatching (FXM) is a standard method to assess recipient and donor compatibility, but can prolong CIT. Single-antigen bead assays allow for detection of recipient donor-specific HLA antibodies, enabling prediction of compatibility through a "virtual crossmatch" (VXM). This study investigates the utility and outcomes of VXM after transplantation of imported pancreata. METHODS We retrospectively compared outcomes of 153 patients undergoing pancreas transplantation at our institution over a 3.5-year period. RESULTS Three patient groups were analyzed based on geographic source of the pancreas graft and the type of prospective crossmatch performed: (1) imported VXM-only, n = 39; (2) imported VXM + FXM, n = 12; and (3) local VXM + FXM, n = 102. There were no episodes of hyperacute rejection and 1 episode of early antibody-mediated rejection (<90 days) in the imported VXM group. Death-censored graft survival, patient survival, and rejection rates were comparable among the recipient groups. For pancreata imported from United Network of Organ Sharing regions 3 and 4, proceeding to surgery without an FXM reduced CIT by 5.1 hours (P < 0.001). The time from organ arrival at the hospital to operation start was significantly shorter in the VXM-only group compared with the VXM + FXM group (P < 0.001). CONCLUSIONS Virtual crossmatch helps minimize CIT without increasing rejection or adversely affecting graft survival, making it a viable method to increase pancreas graft utilization across distant organ sharing regions.
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Abstract
PURPOSE OF REVIEW Patients with type 1 diabetes and end stage renal disease face a complex choice when considering the relative risks and benefits of kidney transplant alone with or without subsequent pancreas after kidney transplant (PAK) or simultaneous kidney pancreas transplant (SPK). RECENT FINDINGS SPK is considered the optimal treatment regarding long-term patient survival, but when also faced with the option of living donor kidney transplant with the potential for PAK later, the ideal option is less clear. SUMMARY This review summarizes the current literature regarding SPK, living donor kidney transplant alone, and PAK transplant outcomes and examines the relative risks of pre- and posttransplant variables that impact patient and graft survival to help inform this complex treatment decision.
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Lam HD, Schaapherder AF, Kopp WH, Putter H, Braat AE, Baranski AG. Professionalization of surgical abdominal organ recovery leading to an increase in pancreatic allografts accepted for transplantation in the Netherlands: a serial analysis. Transpl Int 2016; 30:117-123. [PMID: 27874968 DOI: 10.1111/tri.12893] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/14/2016] [Accepted: 11/18/2016] [Indexed: 02/06/2023]
Abstract
Professional abdominal organ recovery with certification has been mandatory in the Netherlands since 2010. This study analyses the effects of certification (January 2010-September 2015) on pancreas transplantation and compares it to an era before certification (February 2002-May 2008) for surgical injuries and the number of pancreases transplanted. A total of 264 cases were analysed. Eighty-four recovered pancreases (31.8%) with surgically injuries were encountered. Forty-six of those were surgically salvaged for transplantation, resulting in a total of 226 (85.6%) being transplanted. It was found that certified surgeons recovered grafts from older donors (36.8 vs. 33.3; P = 0.021), more often from donation after circulatory death (DCD) donors (18% vs. 0%; P < 0.001) and had less surgical injuries (21.6% vs. 41.0%; P < 0.001). Certification (OR: 0.285; P < 0.001) and surgeons from a pancreas transplant centre (OR: 0.420; P = 0.002) were independent risk factors for surgical organ injury. Predictors for proceeding to the actual pancreas transplantation were a recovering surgeon from a pancreas transplantation centre (OR: 3.230; P = 0.003), certification (OR: 3.750; P = 0.004), donation after brain death (DBD) (OR: 8.313; P = 0.002) and donor body mass index (BMI) (OR: 0.851; P = 0.023). It is concluded that certification in abdominal organ recovery will limit the number of surgical injuries in pancreas grafts which will translate in more pancreases available for transplantation.
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Affiliation(s)
- Hwai-Ding Lam
- Department of Transplantation Surgery, LUMC, Leiden, The Netherlands
| | | | - Wouter H Kopp
- Department of Transplantation Surgery, LUMC, Leiden, The Netherlands
| | - Hein Putter
- Department of Statistics, LUMC, Leiden, The Netherlands
| | - Andries E Braat
- Department of Transplantation Surgery, LUMC, Leiden, The Netherlands
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van Loo ES, Krikke C, Hofker HS, Berger SP, Leuvenink HGD, Pol RA. Outcome of pancreas transplantation from donation after circulatory death compared to donation after brain death. Pancreatology 2016; 17:13-18. [PMID: 27838258 DOI: 10.1016/j.pan.2016.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 11/01/2016] [Accepted: 11/05/2016] [Indexed: 12/11/2022]
Abstract
INTRODUCTION To overcome the gap of organ shortage grafts from donation after circulatory death (DCD) can be used. This review evaluates the outcomes after DCD pancreas donation compared to donation after brain death (DBD). MATERIALS AND METHODS A literature search was performed using Medline, Embase, and PubMed databases. All comparative cohort studies reporting the outcome after DCD and DBD pancreas transplantation were included. All data were assessed according to the Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines. To evaluate the event rates, pooled odds ratios (ORs) as well as the 95% confidence intervals (CI) were calculated. Since the number of studies is small we used the random-effects model only to overcome heterogeneity. RESULTS There is no difference in 1-year pancreas graft survival (OR 1.092, CI 95% 0.649-1.837, P = 0.741) or patient survival (OR 0.699, CI 95% 0.246-1.985, P = 0.502). Simultaneous pancreas-kidney (SPK) transplantation showed significantly higher graft survival rates compared to pancreas transplantation alone (87.2% vs. 76.6%, P < 0.001 in DBD and 86.5% vs. 74.9%, P < 0.001 in DCD). DCD SPK grafts show a higher delayed kidney graft function rate compared to DBD SPK-grafts (OR 0.209, CI 95% 0.104-0.421, P < 0.001). There is significantly less pancreas graft thrombosis after DBD-donation (OR 0.567, CI 95% 0.340-0.946, P = 0.030). We found no difference in the HbA1c level at 1-year follow-up with a median of 5.4% in both groups and a mean of 5.63% (DCD) vs 5.43% (DBD). DISCUSSION DCD pancreas transplantation has comparable patient and 1-year graft survival rates and should be considered a safe alternative for DBD pancreas transplantation.
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Affiliation(s)
- Ellen S van Loo
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Christina Krikke
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Hendrik S Hofker
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Stefan P Berger
- Department of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Henri G D Leuvenink
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
| | - Robert A Pol
- Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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[Simultaneous pancreas and kidney transplantation]. Prog Urol 2016; 26:1053-1065. [PMID: 27720628 DOI: 10.1016/j.purol.2016.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/19/2016] [Accepted: 08/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To perform a State of The Art about the different aspects of pancreas transplantation such as indications, technical features, immunosuppressive strategies and outcomes of simultaneous pancreas-kidney transplantation. MATERIAL AND METHODS An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords (MESH) : « pancreas transplantation; kidney transplantation; simultaneous pancreas-kidney transplantation; immunosuppression ». Publications obtained were selected based on methodology, language, date of publication (last 20 years) and relevance. Prospective and retrospective studies, in English or French, review articles; meta-analysis and guidelines were selected and analyzed. This search found 2736 articles. After reading titles and abstracts, 23 were included in the text, based on their relevance. RESULTS These last few years, considerable progresses were done in optimizing indication for pancreas transplantation, as well as surgical improvement and a better used of immunosuppression. In the first part of this article, demographics, indication and pre-transplant evaluation will be described. The different techniques of procurement, preparation and transplantation will then be discussed. Finally, the results and outcomes of pancreas transplantation will be reported. CONCLUSIONS Despite its morbidity, pancreas transplantation is the optimal treatment of end stage renal disease in diabetic patients under 55. Long-term results and quality of life improvement after pancreas transplantation are excellent. LEVEL OF EVIDENCE NA.
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Kumar L, Surendran S, Kesavan R, Menon RN. Simultaneous pancreas-kidney transplant for type I diabetes with renal failure: Anaesthetic considerations. Indian J Anaesth 2016; 60:131-4. [PMID: 27013753 PMCID: PMC4787125 DOI: 10.4103/0019-5049.176270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Pancreatic grafts have been successfully used in patients with diabetes and are combined with kidney transplantation in patients with renal failure. The propagation of awareness in organ donation in India has increased the donor pool of transplantable organs in the last few years making multi visceral transplants feasible in our country. We present the anaesthetic management of a 32-year-old male with diabetes mellitus and end-stage renal failure who was successfully managed with a combined pancreas and kidney transplantation.
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Affiliation(s)
- Lakshmi Kumar
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Sudhindran Surendran
- Department of Gastrosurgery and Solid Organ Transplant, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Rajesh Kesavan
- Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
| | - Ramachandran Narayana Menon
- Department of Gastrosurgery and Solid Organ Transplant, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India
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Laurence JM, Barbas AS, Sapisochin G, Marquez MA, Bazerbachi F, Selzner M, Norgate A, McGilvray ID, Schiff J, Ross H, Cattral MS. The significance of pre-operative coronary interventions on outcome after pancreas transplantation. Clin Transplant 2015; 30:233-40. [PMID: 26700761 DOI: 10.1111/ctr.12681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2015] [Indexed: 11/28/2022]
Abstract
Pancreas transplant candidates are at very high risk of coronary vascular disease. We hypothesized that the requirement for pre-operative coronary intervention (PCI) may be associated with an adverse impact on short- and long-term outcomes. Retrospective analysis of 366 consecutive primary pancreas transplants was undertaken. Outcomes were compared between recipients who had undergone PCI (n = 48) and those who had not (n = 318). In 48% (23/48) of instances, the PCI was initiated by the transplant cardiology evaluation. The recipients undergoing PCI were older than those not undergoing PCI (47.6 yr vs. 41.9 yr, respectively, p < 0.0001). Although not statistically significant, there was a higher rate of post-operative major cardiovascular events (MCVE) in the PCI group (10.4%) compared with those not undergoing PCI (4.7%) (RR [95% CI]: 2.0 [0.90-4.5]; p = 0.17). In the long term, there were no differences in the rate of death with graft function (p = 0.77) or rejection (p = 0.17). There were no statistically significant differences between the groups with respect to patient (p = 0.54), kidney (p = 0.76), or pancreas (p = 0.63) graft survival. PCI is not a risk factor for short-term perioperative events, and long-term transplant outcomes are equivalent to patients not requiring PCI. PCI, by itself, should not be considered a contraindication for pancreas transplantation, but should raise awareness of perioperative risk.
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Affiliation(s)
- Jerome M Laurence
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada.,RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia
| | - Andrew S Barbas
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Gonzalo Sapisochin
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Max A Marquez
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Fateh Bazerbachi
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Markus Selzner
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Andrea Norgate
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Ian D McGilvray
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Jeffrey Schiff
- Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - Heather Ross
- RPA Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, NSW, Australia
| | - Mark S Cattral
- Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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48
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Ausania F, Drage M, Manas D, Callaghan CJ. A registry analysis of damage to the deceased donor pancreas during procurement. Am J Transplant 2015; 15:2955-62. [PMID: 26484838 DOI: 10.1111/ajt.13419] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 05/18/2015] [Accepted: 06/02/2015] [Indexed: 01/25/2023]
Abstract
Surgical injury to the pancreas is thought to occur commonly during procurement. The UK Transplant Registry was analyzed to determine the frequency of pancreatic injuries, identify factors associated with damage, and assess the impact of injuries on graft survival. Twelve hundred ninety-six pancreata were procured from donation after brain death donors, with 314 (19.5%) from donation after circulatory death donors. More than 50% of recovered pancreata had at least one injury, most commonly a short portal vein (21.5%). Liver donation, procurement team origin, hepatic artery (HA) arising from the superior mesenteric artery (SMA), and increasing donor BMI were associated with increased rates of pancreas damage on univariate analyses; on multivariate analysis only the presence of an HA from the SMA remained significant (p = 0.02). Six hundred forty solid organ pancreas transplants were performed; 238 had some form of damage. Overall, there was no difference in graft survival between damaged and undamaged organs (p = 0.28); however, graft loss was significantly more frequent in pancreata with arterial damage (p = 0.04) and in those with parenchymal damage (p = 0.05). Damage to the pancreas during organ recovery is more common than other organs, and meticulous surgical technique and awareness of damage risk factors are essential to reduce rates of procurement-related injuries.
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Affiliation(s)
- F Ausania
- HPB Surgery, Hospital Xeral, Vigo, Spain
| | - M Drage
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK
| | - D Manas
- HPB and Transplant Surgery, Freeman Hospital, Newcastle, UK
| | - C J Callaghan
- Department of Nephrology and Transplantation, Guy's Hospital, London, UK
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49
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The current challenges for pancreas transplantation for diabetes mellitus. Pharmacol Res 2015; 98:45-51. [DOI: 10.1016/j.phrs.2015.01.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 12/27/2022]
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50
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Multi detector computed tomography (MDCT) for the diagnosis of early complications after pancreas transplantation. ACTA ACUST UNITED AC 2015; 39:1186-92. [PMID: 24852313 DOI: 10.1007/s00261-014-0164-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE Solitary Pancreas (SPT) and simultaneous kidney-pancreas (SPKT) transplants carry a high risk of surgical complications that may lead to the loss of the pancreas graft and impact later kidney function. The purpose of this study was to investigate the role of MDCT in the diagnosis of early complications and its impact on kidney function. METHODS All patients receiving SPT or SPKT over 5 years were retrospectively included. Complications that occurred within the first 15 days were registered and MDCT data analyzed. Data regarding donor, transplant, and recipient characteristics as well as transplantation procedures were analyzed according to the occurrence of early complications. Kidney function at day 3 following MDCT was evaluated. RESULTS One hundred and forty-one patients were included (85 men, 56 women; mean age 40.1 years, SD 7.7) with 119 SPKT and 22 SPT. Sixty-four complications were registered in 50 patients. Partial (P-) or complete venous thrombosis (C-VT) occurred in 12.1 % (n = 17), arterial thrombosis (AT) in 1.4 % (n = 2), and hemorrhage in 8.5 % (n = 12) of all patients. For venous thrombosis, the predominant risk factor was body mass index (BMI) for either recipients (P < 0.05) or donors (P < 0.01). Median time for venous thrombosis diagnosis with MDCT was 4 days. Kidney function was not altered following MDCT. Fourteen pancreatectomies were necessary. All patients with C-VT and AT had to undergo graftectomy. CONCLUSION Vascular complications occurred early following grafting. Systematic early-enhanced MDCT at day 2-3 should be adequate to detect early thrombosis, especially if risk factors have been identified, without induced kidney function alteration.
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