Abstract
BackgroundSimultaneous pancreas kidney transplantation (SPK) is the best therapeutic option for patients with diabetes mellitus type 1 and end-stage renal disease. Recently, donor organ extraction time has been shown to affect kidney and liver graft survival. This study aimed to assess the effect of pancreas donor extraction time on graft survival and postoperative complications. MethodsWe retrospectively analyzed all pancreas transplants performed in two Eurotransplant centers. The association of pancreas extraction time with pancreas graft survival was analyzed by a Cox proportional hazards regression analysis after 3 months, 1 and 5 year. Besides, the effect of pancreas extraction time on the incidence of severe postoperative complications was analyzed. ResultsA total of 317 pancreas transplants were included in this study. Death-censored pancreas graft survival was 85.7% after one year and 76.7% after five years. Median pancreas donor extraction time was 64 min [IQR: 52–79 min]. After adjustment for potential confounders, death censored graft survival after 30 days (HR 1.01, 95% CI 0.9–1.03 (p = 0.23), 1 year (HR 1.01, 95% CI 0.99–1.03 (p = 0.22) and 5 years (HR 1.00, 95% CI 0.99–1.02 (p = 0.57) was not associated with pancreas donor extraction time. However, extraction time was significantly associated with a higher incidence of Clavien-Dindo ≥3 complications compared to Clavien-Dindo 1 + 2 complications: OR 1.012, 95% CI 1.00–1.02 (p = 0.039). ConclusionsOur findings suggest that although no effect on graft survival was found, limiting pancreas extraction time can have a significant impact on lowering postoperative complications.
Highlights
Simultaneous pancreas and kidney transplantation (SPK) is the best therapeutic option for diabetes mellitus type 1 (DM type 1) patients with end-stage renal failure
Comprehensive complication index was non-significantly lower in group 1 (21, interquartile range (IQR) 9e41) versus group 2 (30, IQR 21e45) and group 3 (34, IQR 21e45) [p 1⁄4 0.364]. This is, to our knowledge, the first study addressing the effect of pancreas donor extraction time on outcome after transplantation
Donor organ extraction time is influenced by multiple factors such as the number of organs procured per donor, donor BMI, level of experience of the surgical team and anatomical variations [23]
Summary
Simultaneous pancreas and kidney transplantation (SPK) is the best therapeutic option for diabetes mellitus type 1 (DM type 1) patients with end-stage renal failure. We present the results of a dual-center study with the aim to assess the association between pancreas extraction time, graft survival and postoperative complications. This study aimed to assess the effect of pancreas donor extraction time on graft survival and postoperative complications. The effect of pancreas extraction time on the incidence of severe postoperative complications was analyzed. After adjustment for potential confounders, death censored graft survival after 30 days (HR 1.01, 95% CI 0.9e1.03 (p 1⁄4 0.23), 1 year (HR 1.01, 95% CI 0.99e1.03 (p 1⁄4 0.22) and 5 years (HR 1.00, 95% CI 0.99e1.02 (p 1⁄4 0.57) was not associated with pancreas donor extraction time. Conclusions: Our findings suggest that no effect on graft survival was found, limiting pancreas extraction time can have a significant impact on lowering postoperative complications.
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