Elsevier

Transplantation Proceedings

Volume 43, Issue 9, November 2011, Pages 3267-3269
Transplantation Proceedings

Whole pancreas transplantation
Ten Years of Simultaneous Pancreas-Kidney Transplantation: A Retrospective Single-Center Analysis of Prospectively Obtained Data

https://doi.org/10.1016/j.transproceed.2011.09.099Get rights and content

Abstract

Introduction

Simultaneous pancreas-kidney transplantation (SPK) is a standardized and life-saving procedure for a patient suffering from both insulin-dependent diabetes mellitus type 1 (IDDM 1) and end-stage diabetic nephropathy. To expand the donor pool and to determine the influence of the preprocurement pancreas suitability scoring system (P-PASS) on pancreas graft survival we retrospectively analyzed our data on SPK.

Patients and Methods

From 1999 to 2010 we performed 55 SPKs, using systemic-enteric drainage as surgical approach. The immunosuppressive therapy was induced with basiliximab; maintenance therapy was based on tacrolimus, mycophenolate mofetil, and steroids. Data were prospectively obtained, analyzed, and correlated to the P-PASS.

Results

The overall 10-year patient survival rate was 78% with a 10-year pancreas survival rate of 53%. Three patients needed retransplantation of SPK and 6 patients needed singular pancreas retransplantation. Seventeen patients showed acute rejection episodes and 14 patients suffered from cytomegalovirus (CMV) infections. We compared 43 patients receiving organs from an “ideal” donor (P-PASS <17) with 12 patients receiving grafts from “marginal” donors (P-PASS ≥17). Neither P-PASS nor donor age demonstrated significant influence on pancreas graft survival. However, the body mass index (BMI) of the donor showed a negative tendency (P = .059).

Conclusion

The P-PASS showed no significant prediction of pancreas graft survival. In view of our data, expansion of the German donor pool is possible. A multicenter study of SPK using “marginal” pancreas grafts is mandatory to define a realistic “cut-off” value for P-PASS.

Section snippets

Patients and Methods

From 1999 to 2010 55 SPKs were performed in our center and data were prospectively obtained. All transplantations were performed using systemic-enteric drainage. The arterial anastomosis of superior mesenteric artery and splenic artery was performed using an arterial Y graft. The portal vein was sutured to the lower caval or iliac vein directly.4, 5 The immunosuppressive protocol included induction therapy with basiliximab (20 mg bolus) preoperative and on day 4, respectively. Maintenance

Statistical Analysis

SPSS program 19.0 for Windows (SPSS, Chicago, Ill, United States) was used for statistical analysis. Pancreas graft survival was calculated using the Kaplan-Meier method with statistical significance determined using the log-rank test based on the exact permutation distribution. P < 0.05 was considered significant. For the following parameters with potential influence on organ survival, univariate analyses were performed: P-PASS (</≥17), BMI (</≥25), and donor age (</≥30 years).

Results

In summary, 55 patients received SPK. The patients had suffered from IDDM 1 over a median duration of 27 years. The median duration of dialysis was 2 years. Further donor and recipient data as well as postoperative data are shown in Table 1.

The overall survival rate after 5 years was 83% and after 10 years was 78%. Pancreas graft survival rate was 59% after 5 years and 53% after 10 years. Three patients (5%) needed retransplantation of SPK and 6 patients (11%) needed singular pancreas

Discussion

Several studies have proven the advantage of SPK on patient survival.6, 7 Therefore, SPK should be considered, but suitable pancreas grafts are a scarce resource in the ET area.8, 9 In an effort to expand the donor pool, marginal grafts are accepted. By analyzing 3180 reported pancreas donors between 2002 and 2005, the ET Pancreas Advisory Committee developed the P-PASS.3 A score of <17 identifies an “ideal” donor; scores ≥17 reduce donor acceptance rates, but the impact of P-PASS on clinical

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D.B. Foltys and J.M. Kaths contributed equally to this publication.

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