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Budhiraja P, Reddy KS, Heilman RL, Jadlowiec CC, Khamash H, Reddy S, Katariya N, Chakkera HA. Favorable outcomes in Hispanic recipients receiving simultaneous pancreas kidney transplantation. Clin Transplant 2023; 37:e15062. [PMID: 37378620 DOI: 10.1111/ctr.15062] [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: 02/06/2023] [Revised: 06/08/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023]
Abstract
The objective of this study was to compare the long-term outcomes of Hispanic versus white recipients who underwent simultaneous pancreas kidney transplantation (SPKT). This single-center study, conducted from 2003 to 2022, had a median follow-up of 7.5 years. The study included 91 Hispanic and 202 white SPKT recipients. The mean age (44 vs. 46 years), percentage of males (67% vs. 58%), and body mass index (BMI) (25.6 vs. 25.3 kg/m2 ) were similar between the Hispanic and white groups. The Hispanic group had more recipients with type 2 diabetes (38%) compared to the white group (5%, p < .001). The duration of dialysis was longer in Hispanics (640 vs. 473 days, p = .02), and fewer patients received preemptive transplants (10% vs. 29%, p < .01) compared to whites. Hospital length of stay, rates of BK Viremia, and acute rejection episodes within 1 year were similar between the groups. The estimated 5-year kidney, pancreas, and patient survival rates were also similar between the groups, 94%, 81%, and 95% in Hispanics, compared to 90%, 79%, and 90% in whites. Increasing age and longer duration of dialysis were risk factors for death. Although Hispanic recipients had a longer duration on dialysis and fewer preemptive transplants, the survival rates were similar to those of white recipients. However, referring providers and many transplant centers continue to overlook pancreas transplants for appropriately selected patients with type 2 diabetes, particularly among minority populations. As a transplant community, it is crucial that we make efforts to comprehend and tackle these obstacles to transplantation.
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Affiliation(s)
- Pooja Budhiraja
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Kunam S Reddy
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | | | | | - Hassan Khamash
- Division of Medicine, Mayo Clinic Arizona, Phoenix, Arizona, USA
| | - Swetha Reddy
- Department of Medicine, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Nitin Katariya
- Department of Surgery, Mayo Clinic Arizona, Phoenix, Arizona, USA
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Nolasco L, Igwe D, Smith NK, Sakai T. Abdominal Organ Transplantation: Noteworthy Literature in 2022. Semin Cardiothorac Vasc Anesth 2023; 27:97-113. [PMID: 37037789 DOI: 10.1177/10892532231169075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
This review highlights noteworthy literature published in 2022 pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. We begin by exploring the impacts that the COVID-19 pandemic has had across the field of abdominal organ transplantation, including the successful use of grafts procured from COVID-19-infected donors. In pancreatic transplantation, we highlight several studies on dexmedetomidine and ischemia-reperfusion injury, equity in transplantation, and medical management, as well as studies comparing pancreatic transplantation to islet cell transplantation. In our section on intestinal transplantation, we explore donor selection. Kidney transplantation topics include cardiovascular risk management, obesity, and intraoperative management, including fluid resuscitation, dexmedetomidine, and sugammadex. The liver transplantation section focuses on clinical trials, systematic reviews, and meta-analyses published in 2022 and covers a wide range of topics, including machine perfusion, cardiovascular issues, renal issues, and coagulation/transfusion.
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Affiliation(s)
- Lyle Nolasco
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Divya Igwe
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Natalie K Smith
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, 6595University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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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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Gopal JP, McLean A, Crane J, Herbert P, Papalois V, Dor FJMF, Muthusamy AR. Pancreas Transplantation in Black, Asian and Minority Ethnic Patients-Single Centre Experience in the UK. Transpl Int 2022; 35:10490. [PMID: 35781938 PMCID: PMC9240992 DOI: 10.3389/ti.2022.10490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022]
Abstract
Ethnic disparities in the outcomes after simultaneous pancreas kidney (SPK) transplantation still exist. The influence of ethnicity on the outcomes of pancreas transplantation in the UK has not been reported and hence we aimed to investigate our cohort. A retrospective analysis of all pancreas transplant recipients (n = 171; Caucasians = 118/Black Asian Ethnic Minorities, BAME = 53) from 2006 to 2020 was done. The median follow-up was 80 months. Patient & pancreas graft survival, rejection rate, steroid free maintenance rate, HbA1c, weight gain, and the incidence of secondary diabetic complications post-transplant were compared between the groups. p < 0.003 was considered significant (corrected for multiple hypothesis testing). Immunosuppression consisted of alemtuzumab induction and steroid free maintenance with tacrolimus and mycophenolate mofetil. Pancreas graft & patient survival were equivalent in both the groups. BAME recipients had a higher prevalence of type-2 diabetes mellitus pre-transplant (BAME = 30.19% vs. Caucasians = 0.85%, p < 0.0001), and waited for a similar time to transplantation once waitlisted, although pre-emptive SPK transplantation rate was higher for Caucasian recipients (Caucasians = 78.5% vs. BAME = 0.85%, p < 0.0001). Despite equivalent rejections & steroid usage, BAME recipients gained more weight (BAME = 7.7% vs. Caucasians = 1.8%, p = 0.001), but had similar HbA1c (functioning grafts) at 3-,12-, 36-, and 60-months post-transplant.
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Affiliation(s)
- Jeevan Prakash Gopal
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Adam McLean
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Jeremy Crane
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Paul Herbert
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Vassilios Papalois
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Frank J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Anand Rathnasamy Muthusamy
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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Rogers J, Jay CL, Farney AC, Orlando G, Jacobs ML, Harriman D, Gurram V, Sharda B, Gurung K, Reeves‐Daniel A, Doares W, Kaczmorski S, Mena‐Gutierrez A, Sakhovskaya N, Gautreaux MD, Stratta RJ. Simultaneous pancreas‐kidney transplantation in Caucasian versus African American patients: Does recipient race influence outcomes? Clin Transplant 2022; 36:e14599. [PMID: 35044001 PMCID: PMC9285604 DOI: 10.1111/ctr.14599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/30/2022]
Abstract
The influence of African American (AA) recipient race on outcomes following simultaneous pancreas‐kidney transplantation (SPKT) is uncertain.
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Affiliation(s)
- Jeffrey Rogers
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Colleen L. Jay
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Alan C. Farney
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Giuseppe Orlando
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Marie L. Jacobs
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - David Harriman
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Venkat Gurram
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Berjesh Sharda
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Komal Gurung
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Amber Reeves‐Daniel
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - William Doares
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Scott Kaczmorski
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Alejandra Mena‐Gutierrez
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Natalia Sakhovskaya
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Michael D. Gautreaux
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
| | - Robert J. Stratta
- Department of Surgery Section of Transplantation Atrium Health Wake Forest Baptist Winston‐Salem NC United States
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Li Z, Xiang J, Liu J, Wang L. Race does not predict pancreas graft failure after pancreas transplantation in the Modern Era. Clin Transplant 2021; 36:e14576. [PMID: 34964519 DOI: 10.1111/ctr.14576] [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: 01/03/2021] [Revised: 11/28/2021] [Accepted: 12/23/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND African-American (AA) has historically been associated with inferior graft survival after pancreas transplantation. However, with the improvement of immunosuppression and surgical technique, we hypothesized that the racial disparity has been neutralized. METHODS We analyzed data from the Scientific Registry of Transplant Recipients (1989-2018). Using Kaplan-Meier estimation and Cox proportional hazards regression, we examined the influence of race on pancreatic graft survival. RESULTS Before 2009, AA recipients had a higher risk of pancreatic graft failure after adjusting for confounding factors (hazard ratio [HR]: 1.16, 95% confidence interval [CI]: 1.08-1.24), but the risks for Hispanic and Asian recipients were both comparable to their Caucasian counterparts. However, the risk of pancreatic graft failure in AA recipients dropped to 1% and was no longer significant since 2009 (HR: 1.01, 95%CI: 0.88-1.16). Interestingly, donor race showed similar results. Furthermore, the concordance statistic of the complete pancreas donor risk index (including donor race) was 0.582, whereas the concordance did not change when donor race was eliminated from the model. CONCLUSIONS AA and other races have shown similar pancreatic graft survival in the modern era. Furthermore, donor racial disparity also seems neutralized; thus, donor race should not be considered as an indicator of pancreatic donor quality. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zhiwei Li
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jie Xiang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jianhua Liu
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Li Wang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Smith NK, Zerillo J, Schlichting N, Sakai T. Abdominal Organ Transplantation: Noteworthy Literature in 2018. Semin Cardiothorac Vasc Anesth 2019; 23:188-204. [DOI: 10.1177/1089253219842655] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A PubMed search revealed 1382 articles on pancreatic transplantation, 781 on intestinal transplantation, more than 7200 on kidney transplantation, and more than 5500 on liver transplantation published between January 1, 2018, and December 31, 2018. After narrowing the list down to human studies, 436 pancreatic, 302 intestinal, 1920 liver, and more than 2000 kidney transplantation studies were screened for inclusion in this review.
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Affiliation(s)
- Natalie K. Smith
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Jeron Zerillo
- The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | | | - Tetsuro Sakai
- University of Pittsburgh Medical Center Health System, PA, USA
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Use of Mammalian Target of Rapamycin Inhibitors for Pancreas Transplant Immunosuppression Is Associated With Improved Allograft Survival and Improved Early Patient Survival. Pancreas 2019; 48:644-651. [PMID: 31091210 DOI: 10.1097/mpa.0000000000001322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Mammalian targets of rapamycin inhibitors (mTORi) are considered second-line immunosuppression agents because of associated increases in rejection and impaired wound healing. Recent reports indicate mTORi have been linked to improved survival, decreased inflammatory response in pancreatitis, and antiproliferative and antiangiogenic activity. Mammalian targets of rapamycin inhibitors have not been extensively analyzed in pancreas transplant recipients. METHODS Adults with pancreas and kidney-pancreas transplants from 1987 to 2016 in the United Network for Organ Sharing database were analyzed (N = 25,837). Subjects were stratified into 2 groups: use of mTORi (n = 4174) and use of non-mTORi-based immunosuppression (n = 21,663). The log-rank test compared survival rates. Univariate and multivariate Cox regression analyses assessed patient and graft survival. RESULTS Mammalian targets of rapamycin inhibitors were associated with a 7% risk reduction in allograft failure (hazard ratio, 0.931; P = 0.006). Allograft survival rates were significantly different between mTORi versus non-mTORi (P < 0.0001).The mTORi group showed a significantly higher patient survival rate 1, 3, 5, and 10 years posttransplant compared. Patient survival at 15 years was not significantly different. CONCLUSIONS The use of mTORi for immunosuppression in pancreas transplant is associated with improved allograft survival and early patient survival posttransplant (up to 10 years).
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Siskind E, Amodu L, Liu C, Akerman M, Stodghill J, Wali R, Piper J, Jonsson J, Molmenti E, Ortiz J. A comparison of portal venous versus systemic venous drainage in pancreas transplantation. HPB (Oxford) 2019; 21:195-203. [PMID: 30166090 DOI: 10.1016/j.hpb.2018.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 07/05/2018] [Accepted: 07/12/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The decision to utilize portal or systemic venous drainage in pancreas transplantation is surgeon- and center-dependent. Information regarding the superior method is based on single-center reports and animal models. METHODS UNOS data on adults receiving pancreas and kidney-pancreas transplants from 1987 to 2016 were analyzed (n = 29 078). The groups analyzed were: systemic venous pancreas graft drainage (SVD, n = 24 512) or portal venous pancreas graft drainage (PVD, n = 4566). A Cox proportional hazard model compared patient and allograft survival between groups. RESULTS No statistically significant differences were observed for patient and allograft survival at 1, 3, 5, 10, or 15 years post-transplant at each time interval and cumulatively (patient - HR:1.041; 95% CI:0.989-1.095; allograft - HR:0.951; 95% CI:0.881-1.027). PVD reduced the risk of death by 22.0% (P = 0.017) compared to SVD for patients undergoing pancreas after kidney transplant (PAK); no statistically significant difference was found for patients undergoing other types of transplants. CONCLUSION There is no significant clinical difference in patient or allograft survival between PVD and SVD in pancreas transplantation for the majority of patients. For the subgroup of PAK, PVD was associated with decreased mortality. For individual surgeons, center and patient scenarios should dictate which technique is performed.
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Affiliation(s)
- Eric Siskind
- Inova Fairfax Medical Campus, Department of Surgery, Inova Kidney and Pancreas Transplant Program, 3300 Gallows Road, Falls Church, VA, 22042, USA.
| | - Leo Amodu
- Northwell Health System, Transplant Center, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Chang Liu
- Inova Fairfax Medical Campus, Department of Surgery, Inova Kidney and Pancreas Transplant Program, 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - Meredith Akerman
- Northwell Health System, Transplant Center, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Joshua Stodghill
- Inova Fairfax Medical Campus, Department of Surgery, Inova Kidney and Pancreas Transplant Program, 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - Ravinder Wali
- Inova Fairfax Medical Campus, Department of Surgery, Inova Kidney and Pancreas Transplant Program, 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - James Piper
- Inova Fairfax Medical Campus, Department of Surgery, Inova Kidney and Pancreas Transplant Program, 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - Johann Jonsson
- Inova Fairfax Medical Campus, Department of Surgery, Inova Kidney and Pancreas Transplant Program, 3300 Gallows Road, Falls Church, VA, 22042, USA
| | - Ernesto Molmenti
- Northwell Health System, Transplant Center, 300 Community Drive, Manhasset, NY, 11030, USA
| | - Jorge Ortiz
- University of Toledo Medical Center Kidney Transplant Program, 3000 Arlington Avenue, Toledo, OH, 43614, USA
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