Influence of Peritoneal or Hemodialysis on Results of Simultaneous Pancreas and Kidney Transplant

COVID-19 Vaccines in Pancreatic Transplant Recipients: A Single-Center Observative Study

The SARS-CoV-2 pandemic was a real test of doctors' abilities to adapt and respond to patients' needs. The course of infection varied from influenza-like symptoms to severe infections with multi-organ failure and death. Therefore, the possibility of vaccination against the COVID-19 virus brought great hope. Since 2004, 240 pancreas and pancreas with kidney (simultaneous pancreas and kidney transplantation, pancreas after kidney, pancreas transplants alone) transplants were performed in our center. Currently, 130 transplant patients are under the care of the transplant clinic. All patients were informed about the possibility of vaccination against SARS-CoV-2 with the mRNA vaccine. The aim of the study was to evaluate the development of antibodies to SARS-CoV-2 in patients who had previously undergone transplantation. Fifty-three patients were vaccinated with the full double dose and 37 patients received an additional third dose. The level of antibodies in the IgM and IgG classes was assessed in patients' serum. The level of antibodies was assessed before administration of the vaccine and then after administration of the first and second doses. Most patients had no response to vaccination after 1 dose of the vaccine and 21 patients achieved therapeutic antibody levels after the full dose of vaccination. However, the highest titer of immunoglobulins was found in recipients who received the third dose. The use of vaccinations is safe and can protect the group of patients after pancreas transplantation from serious complications of SARS-CoV-2 infection despite the use of immunosuppressive drugs.

Vascular Complications After Simultaneous Pancreas and Kidney Transplantation: A Case Report

A 51-year-old patient with type I diabetes and end-stage renal disease was qualified for a simultaneous kidney and pancreas transplant. The procedure was performed in a typical manner: arterial anastomosis to the right common iliac artery, the graft's portal vein with inferior vena cava, and side-to-side duodenal intestinal anastomosis. The kidney was implanted retroperitoneally. Six months after the transplant, the patient reported pain in the right lower abdomen, and imaging examinations revealed arterial anastomosis. Reconstruction of the right common iliac artery was performed with a Gore-Tex prosthesis and the pancreatic artery reanastomosed to the right external iliac artery. After the surgery, the function of the transplanted pancreas deteriorated, the level of C-peptide was decreased, and the patient required low doses of insulin. After another 8 months, the imaging studies revealed an aneurysm located in the bifurcation of the aorta up to the anastomosis of the pancreatic graft artery with the iliac artery. The patient was qualified for the implantation of an endovascular of 2 prosthesis, which improved the graft's function. After another 2 months, the presence of an aneurysm at the endovascular prosthesis was found again. The patient was requalified for endovascular prosthesis implantation. Currently, there is no aneurysm but the function of the pancreas graft is impaired, though the kidney graft function is good. Patients after simultaneous kidney and pancreas transplant are a group of patients with an increased risk of vascular complications. Treatment should take place in a multidisciplinary center.

The course of Covid-19 infection in patients after pancreas and kidney transplantation – a single - centre observation

Solid graft recipients are at an increased risk of serious complications and death. Out of 130 outpatient recipients of pancreas grafts at our Clinic, 20 patients (15.73%) had a confirmed severe acute respiratory syndrome coronavirus 2 infection (SARS-CoV-2). Each patient had a different course of the disease, and the forms of infection varied from mild to severe and lethal. According to recommendations, after confirmation of the infection, mycophenolate mofetil was withdrawn and the immunosuppression was based on steroids and a calcineurin inhibitor. In this study, we performed an analysis of the course of COVID-19 infection in patients after pancreatic transplantation. Twenty pancreas recipients were confirmed to have COVID-19 infections; 4 of whom required hospitalization owing to severe complications. Patients reported weakness, excessive intensity of fatigue, shortness of breath with exertion, cough, and periodically increased temperature. Weakness and fatigue persisted in these patients for about 6 weeks. In 2 patients there was a need for oxygen supplementation and empirical antibiotic. Mortality was 5%, and there was 1 graftectomy. Deterioration of either kidney or pancreas graft were not observed in any other patients.

The course of SARS-CoV-2 infection in solid graft recipients is similar to that of the rest of the population. Because of immunosuppression, recipients were accustomed to avoiding crowds and complying with obligations to wear masks.