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Raveh Y, Rodriguez Y, Pretto E, Souki F, Shatz V, Ashrafi B, Manmohansigh V, Demos M, Livingstone J, Nasrallah G, Andrews D, Beduschi T, Vianna R, Nicolau-Raducu R. Thrombotic and hemorrhagic complications during visceral transplantation: risk factors, and association with intraoperative disseminated intravascular coagulation-like thromboelastographic qualities: a single-center retrospective study. Transpl Int 2018; 31:1125-1134. [DOI: 10.1111/tri.13281] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/09/2018] [Accepted: 05/15/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Yehuda Raveh
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Yiliam Rodriguez
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Ernesto Pretto
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Fouad Souki
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Vadim Shatz
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Behrouz Ashrafi
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Vinaya Manmohansigh
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Michael Demos
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Joshua Livingstone
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Georges Nasrallah
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - David Andrews
- Pathology Department; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Thiago Beduschi
- Miami Transplant Institute; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Rodrigo Vianna
- Miami Transplant Institute; Jackson Memorial Hospital; University of Miami; Miami FL USA
| | - Ramona Nicolau-Raducu
- Department of Anesthesia; Jackson Memorial Hospital; University of Miami; Miami FL USA
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Martins LS, Malheiro J, Pedroso S, Almeida M, Dias L, Henriques AC, Silva D, Davide J, Cabrita A, Noronha IL, Rodrigues A. Pancreas-Kidney transplantation: Impact of dialysis modality on the outcome. Transpl Int 2015; 28:972-9. [PMID: 25790131 DOI: 10.1111/tri.12565] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 12/31/2014] [Accepted: 03/15/2015] [Indexed: 12/18/2022]
Abstract
It remains controversial whether dialysis modality prior to SPKT (simultaneous pancreas-kidney transplantation) affects the outcome. We analyzed outcomes in type 1 diabetic patients undergoing SPKT, comparing peritoneal dialysis (PD) and hemodialysis (HD) groups: 119 had been on HD; 39 on PD. They were comparable except regarding dialysis time, higher in HD patients (30 ± 23 vs. 21 ± 15 months, P = 0.003). Thrombosis-driven relaparotomy was more frequent in PD patients (12.8% vs. 1.7%, P = 0.014). Pancreas loss due to infection was higher in PD patients (12.8% vs. 3.4%, P = 0.042). Thrombosis-related kidney loss was more frequent in PD patients (5.1%, vs. 0% in HD patients, P = 0.058). Thirteen deaths occurred, more within the PD group (17.9% vs. 5%; P = 0.011), being infection the leading cause (13.5%, vs. 1.7% in HD patients, P = 0.010). Patient survival was inferior in PD patients. Besides PD, cardiovascular disease and graft failure were independent predictors of patient death. In conclusion, PD patients more frequently complicated with intra-abominal infection leading to pancreatic loss and with renal thrombosis, with adverse impact on survival. As a PD first strategy in end-stage renal disease patients is generally associated with good outcomes, these gloomier results after SPKT urge for careful adjustment of infection and thrombosis prophylactic protocols in PD patients.
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Affiliation(s)
- La Salete Martins
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.,Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Jorge Malheiro
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal
| | - Sofia Pedroso
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.,Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Manuela Almeida
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.,Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Leonidio Dias
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - António C Henriques
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.,Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Donzília Silva
- Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Surgery Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - José Davide
- Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Surgery Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - António Cabrita
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal
| | - Irene L Noronha
- Cellular and Molecular Nephrology Laboratory, Division of Nephrology, University of São Paulo, São Paulo, Brazil
| | - Anabela Rodrigues
- Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.,Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal
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3
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Scalea JR, Cooper M. Current concepts in the simultaneous transplantation of kidney and pancreas. J Intensive Care Med 2011; 27:199-206. [PMID: 21576190 DOI: 10.1177/0885066610396813] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetes mellitus (DM) represents an enormous health care concern for the United States and other countries. According to the American Diabetes Association in 2007, there were more than 23 million Americans living with diabetes. This is a 13.5% increase from 2005, likely representing increases in Type II DM (DMII). Diabetes mellitus results when the beta cells of the pancreas are unable to produce sufficient insulin to prevent hyperglycemia. Simultaneous pancreas and kidney transplantation, or SPK, may be indicated for patients that have experienced renal failure as a complication of DM (either type I or type II). Until recently, technical failure represented a significant impediment to the success of pancreas transplantation. At the turn of the century, however, both renal and pancreatic graft survival dramatically improved. Immunologic and nonimmunologic causes of graft failure continue to challenge inpatient and outpatient management. With vigilance in the ICU postoperatively and in the clinic, SPK can provide significant benefit both in patient survival and quality of life.
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Affiliation(s)
- Joseph R Scalea
- Division of Transplantation, Department of Surgery, University of Maryland School of Medicine, Baltimore, MD 21201, USA
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Navarro A, Castro MJ, Cabello M, Aranda JM, Burgos D, Lopez B, Perez A, Solas E. Outcome and morbidity of pancreas transplantation in a single Spanish institution. Transplant Proc 2006; 38:1543-8. [PMID: 16797354 DOI: 10.1016/j.transproceed.2006.02.082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2005] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pancreas transplantation is nowadays the only treatment to reestablish normal blood glucose in diabetic patients. Moreover, transplantation may also prevent and possibly even revert diabetes-related complications. We present our results with the first 4 years of a pancreas transplantation program. MATERIALS AND METHODS From February 2000 to June 2004, we performed 43 pancreas transplants in 42 recipients. In all cases the technique was enteric drainage of the exocrine secretions and systemic venous derivation to the inferior vena cava for endocrine secretions. RESULTS A simultaneous pancreas-kidney transplant was performed in 37 (88.1%) patients, a pancreas after kidney in 4 (9.5%) patients, and a retransplant in 1 (2.4%) patient. Glycosylated hemoglobin and C peptide returned to normal values in all cases. Patient and graft survivals were 91% and 84%, respectively, after a median follow-up of 19 months. The rate of reoperations was 31% with an overall 16% graft loss. CONCLUSIONS Our results were comparable to those of larger series.
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Affiliation(s)
- A Navarro
- Hospital Carlos Haya, Malaga, Spain.
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Fertmann JM, Wimmer CD, Arbogast HP, Illner WD, Tarabichi A, Calasan I, Dieterle C, Land W, Jauch KW, Hoffmann JN, Johannes NH. Single-shot antithrombin in human pancreas-kidney transplantation: reduction of reperfusion pancreatitis and prevention of graft thrombosis*. Transpl Int 2006; 19:458-65. [PMID: 16771866 DOI: 10.1111/j.1432-2277.2006.00325.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Reperfusion pancreatitis and graft thrombosis often induce early graft loss in simultaneous pancreas-kidney (SPK) transplantation. Antithrombin (AT) is a coagulatory inhibitor with pleiotropic activities that reduces experimental ischemia/reperfusion injury. This study retrospectively analyses prophylactic high-dose AT application in patients with first SPK. In an university transplantation center, 53 consecutive patients with SPK were studied without randomization. In one group, 3000 IU of AT was given intravenously before pancreatic reperfusion (AT, n = 24). Patients receiving standard therapy including postoperative AT supplementation (controls, n = 29) served as controls. Daily blood sampling was performed as a part of the clinical routine during four postoperative days. There were no differences in demographic and laboratory parameters [donor/recipient age, ischemia time, perfusion solution, body weight, mismatches] between both groups. Baseline creatinine values were lower in the control group versus AT group (P < 0.05). Coagulatory parameters and bleeding incidence were not influenced by AT, while incidence of graft thrombosis was reduced (control: 7/29; AT: 4/24; relative reduction of risk: -33%; P < 0.05). Single-shot AT application during SPK modulated serum lipase activity on postoperative days 2 and 3, and minimized risk for graft thromboses without increasing perioperative bleeding. This new concept should deserve testing in a prospective clinical trial.
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Affiliation(s)
- Jan M Fertmann
- Department of Surgery, Ludwig Maximilians University of Munich Grosshadern, Munich, Germany
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Navarro-Piñero A, Castro-Santiago MJ, Aranda-Narváez JM, Cabello-Díaz M, Sola-Moyano E, López Rueda B, Pérez-Daga JA, Ramírez-Plaza CP, Burgos-Rodríguez D, González-Molina M, de la Fuente-Perucho A. Trasplante de páncreas: resultados del grupo Málaga. Cir Esp 2006; 79:101-7. [PMID: 16539948 DOI: 10.1016/s0009-739x(06)70828-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Pancreatic transplantation is currently the only therapeutic alternative able to restore normal blood glucose levels in diabetic patients. Moreover, this procedure can halt or even reverse diabetes-related complications. The aim of this study was to present our experience and the results of the first 4 years of a pancreatic transplantation program in our center. MATERIAL AND METHOD From February 2000 to June 2004, 43 pancreatic transplantations were performed in 42 recipients in the Carlos Haya Regional Hospital in Malaga (Spain). In all patients, the technique of enteric drainage of exocrine pancreatic secretions and systemic venous shunting of endocrine secretions (to the inferior vena cava) was used. RESULTS There were 37 (88.1%) simultaneous pancreas-kidney transplantations, 4 (9.5%) in patients with prior kidney transplantation and 1 retransplantation (2.4%). In all patients, glycosylated hemoglobin and C-peptide levels returned to normal. Patient and pancreatic graft survival were 91% and 84%, respectively, with a median follow-up of 19 months. The reintervation rate was 31%, with an overall rate of graft loss of 16%. CONCLUSIONS The results obtained in our series are similar to those reported for large series.
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Affiliation(s)
- Alfonso Navarro-Piñero
- Servicio de Cirugía General, Digestiva y Trasplante de Organos Sólidos Abdominales, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
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