Influence of Donor and Recipient Sex Matching in Simultaneous Pancreas-Kidney Transplantation Outcomes

BACKGROUND

Several studies in solid organ transplantation have shown a correlation between donor and recipient sex mismatch and risk of graft loss; however, it is possible influence is not well established. The aim of our study was to review the outcomes of pancreatic and kidney grafts in our series depending on sex matching.

METHODS

We retrospectively analyzed a cohort of 199 patients who underwent simultaneous pancreas-kidney transplantation from February 1989 to June 2019 at the Reina Sofia University Hospital.

RESULTS

Survival of patients in the series was 93.5% at 5 years, 84.3% at 10 years, and 71.5% at 15 years. In the sex-discordant group, survival of patients in the series at 5, 10, and 15 years was 94%, 82.3%, and 71.7% compared with 92.3%, 85.1%, and 72.2% in the concordant group, with no statistically significant differences (P = .86). Pancreatic graft survival censored for death at 5, 10, and 15 years was 79.5%, 60.8%, and 57.5% in the group with discordant sex vs 77.5%, 67.8%, and 65.5% in the concordant group, finding no statistically significant differences (P = .54). Kidney graft survival censored for death at 5, 10, and 15 years was 89.3%, 85%, and 78.1% in the sex-discordant group vs 87.3%, 83.5%. and 78.8% in the concordant group, with no differences (P = .69). No differences were observed between the 2 groups in the rate of serious postoperative complications or acute rejection.

CONCLUSION

Our study shows that donor-recipient sex mismatch in simultaneous pancreas-kidney transplantation does not negatively influence perioperative outcomes and survival of the patient and both grafts.

Systemic inflammatory markers for the detection of infectious complications and safe discharge after cytoreductive surgery and HIPEC

INTRODUCTION

Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) in patients with ovarian peritoneal carcinomatosis may be associated with a high postoperative morbidity. An early discrimination of postoperative complications is crucial for both improving clinical outcomes and proposing a safe discharge.

MATERIAL AND METHODS

In a cohort of 122 patients with advanced ovarian cancer (FIGO III-IV), we analyzed the diagnostic performance of three systemic inflammatory markers (C-reactive protein, white blood cell count and systemic immune-inflammation index) between the 5th to 8th postoperative days to prediction postoperative infectious complications. An optimal cut-off value was established in order to discriminate between the group of patients who developed infectious complications or not during the postoperative period.

RESULTS

The median peritoneal carcinomatosis index (PCI) was 15. The overall infectious morbidity was 25.4% (31 patients out of 122), of which, 32% (10 patients out of 31) had suffered severe postoperative complications (Dindo-Clavien III-IV). The most accurate results for detecting infectious complications were obtained by using C-reactive protein, which presented an excellent diagnostic performance, especially on the 7th and 8th postoperative days (AUC = 0,857 and 0,920; respectively).

CONCLUSIONS

These results support that it is safe to discharge patients with C-reactive protein concentrations lower than 88 mg/L and 130 mg/L, on the 7th and 8th postoperative days, respectively.