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Adler JT, Zaborek N, Redfield RR, Kaufman DB, Odorico JS, Sollinger HW. Enteric conversion after bladder-drained pancreas transplantation is not associated with worse allograft survival. Am J Transplant 2019; 19:2543-2549. [PMID: 30838785 DOI: 10.1111/ajt.15341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 02/24/2019] [Accepted: 02/26/2019] [Indexed: 01/25/2023]
Abstract
In the early experience of pancreas transplantation, bladder drainage was favored, but it often caused urologic, metabolic, and infectious complications that necessitated conversion to enteric drainage. Long-term graft survival after enteric conversion and the impact of time interval from transplantation to enteric conversion on graft survival is poorly understood. We studied all bladder-drained first-time pancreas transplantations performed at the University of Wisconsin from 1985 to 2000. Time to conversion was estimated with the Kaplan-Meier technique, whereas risk factors associated with conversion were estimated via a time-varying Cox proportional hazards model. Of 386 bladder-drained pancreata, 162 (41.9%) eventually required enteric conversion, 29 (17.9%) within the first year. Median time to conversion varied by indication: 0.68 years for surgical, 3.1 years for urologic, and 2.7 years for metabolic disorders. In a time-varying Cox model adjusting for donor and recipient factors, enteric conversion did not affect the risk of pancreas graft loss (hazard ratio [HR] 0.86, P = .26). Kidney survival was not associated with enteric conversion. When necessary due to symptoms or complications, enteric conversion of bladder-drained pancreata is safe and does not affect overall graft survival. This relationship appears to be true no matter when the conversion is performed.
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Affiliation(s)
- Joel T Adler
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Nick Zaborek
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Robert R Redfield
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Dixon B Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Jon S Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
| | - Hans W Sollinger
- Division of Transplantation, Department of Surgery, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
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Choi JY, Jung JH, Kwon HW, Shin S, Kim YH, Han DJ. Does Enteric Conversion Affect Graft Survival After Pancreas Transplantation with Bladder Drainage? Ann Transplant 2018; 23:89-97. [PMID: 29391389 PMCID: PMC6248072 DOI: 10.12659/aot.907192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Although bladder drainage is effective for monitoring urine amylase levels to detect graft rejection, enteric drainage is performed more frequently. The optimal method for monitoring pancreatic enzyme secretions remains unclear. We investigated graft survival in recipients of bladder drainage and assessed the risk of graft rejection and failure after enteric conversion. Material/Methods From January 1999 to October 2015, we performed 318 pancreas transplantations at our institution. We enrolled 180 recipients who underwent pancreas transplantation with bladder drainage (82 underwent enteric conversion and the rest did not). Results The mean interval between pancreas transplantation and enteric conversion was 20±24 months. The graft survival rate was significantly higher in the enteric conversion group for 10 years after pancreas transplantation than in the maintain bladder drainage group. After enteric conversion, 14 recipients lost graft function. The interval between enteric conversion and graft failure was 43±26 months. In the enteric conversion group, immediate postoperative thromboembolectomy (HR=12.729, p=0.000), renal failure (HR=5.710, p=0.005), pancreas graft rejection after EC (HR=19.006, p=0.000), and delayed graft function (HR=7.021, p=0.001) had a significant relationship with graft failure. Conclusions Enteric conversion can be safe and effective for improving short- and long-term graft survival if performed after approximately 9 months. Caution should be exercised with enteric conversion if recipients have a history of thromboembolectomy, delayed graft function, or renal failure.
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Affiliation(s)
- Ji Yoon Choi
- Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Joo Hee Jung
- Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Hyun Wook Kwon
- Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Sung Shin
- Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Young Hoon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
| | - Duck Jong Han
- Division of Kidney and Pancreas Transplantation, Department of Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea
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Kleespies A, Mikhailov M, Khalil PN, Pratschke S, Khandoga A, Stangl M, Illner WD, Angele MK, Jauch KW, Guba M, Werner J, Rentsch M. Moon phases and moon signs do not influence morbidity, mortality and long-term survival, after living donor kidney transplantation. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:440. [PMID: 28870250 PMCID: PMC5584333 DOI: 10.1186/s12906-017-1944-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 08/21/2017] [Indexed: 11/21/2022]
Abstract
Background Approximately 11% of the German population are convinced that certain moon phases and moon signs may impact their health and the onset and clinical course of diseases. Before elective surgery, a considerable number of patients look to optimize the timing of the procedure based on the lunar cycle. Especially patients awaiting living donor kidney transplantation (LDKT) commonly look for an adjustment of the date of transplantation according to the moon calendar. This study therefore investigated the perioperative and long-term outcome of LDKT dependent on moon phases and zodiac signs. Methods Patient data were prospectively collected in a continuously updated kidney transplant database. Two hundred and seventy-eight consecutive patients who underwent LDKT between 1994 and December 2009 were selected for the study and retrospectively assigned to the four moon phases (new-moon, waxing-moon, full-moon, and waning-moon) and the corresponding zodiac sign (moon sign Libra), based on the date of transplantation. Preexisting comorbidities, perioperative mortality, surgical outcome, and long-term survival data were analyzed. Results Of all LDKT procedures, 11.9, 39.9, 11.5, and 36.5% were performed during the new, waxing, full, and waning moon, respectively, and 6.2% during the moon sign Libra, which is believed to interfere with renal surgery. Survival rates at 1, 5, and 10 years after transplantation were 98.9, 92, and 88.7% (patient survival) and 97.4, 91.6, and 80.6% (graft survival) without any differences between all groups of lunar phases and moon signs. Overall perioperative complications and early graft loss occurred in 21.2 and 1.4%, without statistical difference (p > 0.05) between groups. Conclusion Moon phases and the moon sign Libra had no impact on early and long-term outcome measures following LDKT in our study. Thus, concerns of patients awaiting LDKT regarding the ideal time of surgery can be allayed, and surgery may be scheduled independently of the lunar phases.
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Manuel O, Toso C, Pascual MA. Kidney and Pancreas Transplant Recipients. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kukla A, Radosevich DM, Finger EB, Kandaswamy R. High urine amylase level and the risk of enteric conversion in solitary pancreas transplant recipients. Transplant Proc 2015; 46:1938-41. [PMID: 25131076 DOI: 10.1016/j.transproceed.2014.05.081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Compared with enteric drainage, bladder-drained solitary pancreas transplants can be monitored for rejection by measuring urine amylase levels. However, bladder drainage is associated with a higher risk of infection and metabolic complications, necessitating enteric conversion in about one third of patients. We hypothesized that hypersecreting pancreata with high urine amylase levels have a higher propensity for enteric conversion from an antecedent elevated enzymatic effect on the urinary tract and increased fluid losses. PATIENTS AND METHODS We analyzed the risk for enteric conversion in 312 bladder-drained solitary pancreas transplant recipients. Urine amylase levels at 30 days were used to identify those at risk for enteric conversion. Time-to-event analysis was used to evaluate the risk of enteric conversion at 10 years, adjusting for urine amylase level and other confounding factors. Confounding risk factors statistically related to enteric conversion were incorporated into the multivariable analysis by using Cox proportional hazards regression at 3 years' posttransplant. RESULTS During the median follow-up of 184.6 months, 31% of recipients underwent duct conversion. A majority of recipients (84.5%) who required duct conversion were primary transplants. The 30-day median urine amylase level was 1749 IU/h (quartile 1, <777 IU/h; quartile 3, ≥3272 IU/h). Using receiver operating characteristic analysis, it was determined that urine amylase levels >3272 IU/h had the greatest specificity for predicting risk of enteric conversion. In the multivariate analysis, high urine amylase levels increased the risk of enteric conversion only in repeated pancreas transplants. CONCLUSIONS Primary transplants are more likely to undergo enteric conversion than retransplants. High urine amylase levels increase the risk of enteric conversion in retransplants only, and therefore this enzyme alone cannot serve as the sole predictor for conversion in primary transplants. Other factors, such as fluid and bicarbonate losses, increased bladder pressure, and a pre-existing lower urinary tract pathologic condition may be also responsible for the development of complications; these factors warrant additional study.
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Affiliation(s)
- A Kukla
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, Minnesota
| | - D M Radosevich
- Department of Surgery, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - E B Finger
- Department of Surgery, Department of Medicine, University of Minnesota, Minneapolis, Minnesota
| | - R Kandaswamy
- Department of Surgery, Department of Medicine, University of Minnesota, Minneapolis, Minnesota.
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Kim SM, Youn WY, Kim DJ, Kim JS, Lee S. Simultaneous pancreas-kidney transplantation: lessons learned from the initial experience of a single center in Korea. Ann Surg Treat Res 2015; 88:41-7. [PMID: 25553324 PMCID: PMC4279990 DOI: 10.4174/astr.2015.88.1.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 08/04/2014] [Accepted: 08/07/2014] [Indexed: 01/26/2023] Open
Abstract
Purpose The purpose of this study is to report the results of simultaneous pancreas-kidney (SPK) transplantations and describe the lessons learned from the early experiences of a single center. Methods Between January 2002 and June 2013, a total of 8 patients underwent SPK transplantation. Clinical and radiologic data were reviewed retrospectively. Results Seven patients were diagnosed with type I diabetes mellitus and one patient became insulin-dependent after undergoing a total pancreatectomy because of trauma. Pancreas exocrine drainage was performed by enteric drainage in 4 patients and bladder drainage in 4 patients. Three patients required conversion from initial bladder drainage to enteric drainage due to urinary symptoms and duodenal leakage. Four patients required a relaparotomy due to hemorrhage, ureteral stricture, duodenal leakage, and venous thrombosis. There was no kidney graft loss, and 2 patients had pancreas graft loss because of venous thrombosis and new onset of type II diabetes mellitus. With a median follow-up of 76 months (range, 2-147 months), the death-censored graft survival rates for the pancreas were 85.7% at 1, 3, and 5 years and 42.9% at 10 years. The patient survival rate was 87.5% at 1, 3, 5, and 10 years. Conclusion The long-term grafts and patient survival in the current series are comparable to previous studies. A successful pancreas transplant program can be established in a single small-volume institute. A meticulous surgical technique and early anticoagulation therapy are required for further improvement in the outcomes.
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Affiliation(s)
- Suh Min Kim
- Department of Surgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Woo Young Youn
- Department of Surgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Doo Jin Kim
- Department of Surgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Joo Seop Kim
- Department of Surgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Samuel Lee
- Department of Surgery, Hallym University Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Current world literature. Curr Opin Organ Transplant 2013; 18:111-30. [PMID: 23299306 DOI: 10.1097/mot.0b013e32835daf68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
SPK transplant is the definitive treatment of type 1 diabetes combined with end-stage renal disease. Long-term graft function can lead to improvement in diabetes-related complications and, in patients younger than 50 years, can lead to improved overall survival. PAK transplant and PA transplant do not result in similar improvements in patient survival, but with appropriate patient selection, they can improve quality of life by rendering patients insulin-free. Pancreas transplant is associated with more surgical complications and higher perioperative morbidity and mortality than KTA. Therefore, careful donor and recipient selection along with meticulous surgical technique are mandatory for optimal outcomes.
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Affiliation(s)
- Kiran K Dhanireddy
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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