Simultaneous Pancreas-kidney Research Articles

Effect of Delayed Graft Function on Early Pancreatic Graft Failure in Simultaneous Pancreas-Kidney Transplant Recipients

Effect of Delayed Graft Function on Early Pancreatic Graft Failure in Simultaneous Pancreas-Kidney Transplant Recipients

Second and Third Chance to Stop Having Diabetes. Pancreas Retransplant With Functional Kidney Graft: A Single-Center Experience

Simultaneous pancreas-kidney (SPK) transplant is the primary option in patients with type 1 diabetes mellitus who develop end-stage kidney disease. Pancreas retransplant (PRt) has become an alternative in patients who experience pancreas graft failure (PGF). There is a lack of evidence regarding PRt in international registers. There are small series of published research with indeed heterogeneous results. We aim to compare PRt outcomes with primary SPK transplant in our center. The study was designed as a descriptive study of a cohort of 234 patients who received SPK transplant and received another PRt because of PGF at Reina Sofía University Hospital between 1988 and 2021. Kaplan-Meier analysis was performed to calculate patient and allograft survival. Of these 234 SPK transplants, 53 pancreas grafts (22.6%) were lost initially. In total, 15 PRts were performed. The major cause of first PGF was surgical, whereas the medical cause was the most frequent in the PRt group. There were 60 deaths in the SPK group compared with only 1 in the PRt group. In Kaplan-Meier analysis, the PRt group showed worse survival than the SPK group, with statistically significant difference between groups (P=.05). Patient survival was not different between both groups. PRt constitutes a viable option for recipients who experience PGF in the absence of formal contraindication. Although graft retransplant survival seems to be inferior to first graft in our series, these results are difficult to compare because of the scarce number of procedures performed.

Different timing and risk factors of cause-specific pancreas graft loss after simultaneous pancreas kidney transplantation

In cases after pancreas transplantation (PTx), the pancreas graft might be lost for various reasons, including a pancreatoduodenal graft-related complication or patient death with a functioning graft. Although the causes seem to have distinct characteristics, the causes of pancreas graft loss have not been characterized. This study aimed to characterize the causes of pancreas graft loss by analyzing data from a Japanese nationwide registry. This study included 391 patients who received simultaneous pancreas-kidney transplantation among 461 patients with PTx during the study period in approved institutions in Japan. We characterized each cause in terms of the timing of the cause-specific graft loss and preoperative factors associated with graft loss based on nationwide data from a Japanese nationwide registry. Among the 391 cases, 113 lost the pancreas graft due to patient death with a functioning graft (DWFG; n = 34, 44.2%), graft thrombus (n = 22, 28.6%), or chronic rejection (CR; n = 7, 9.1%). Average (± standard deviation) time from PTx to graft loss due to DWFG, graft thrombus, and CR was 3.70 ± 4.36, 0.02 ± 0.01, and 2.37 ± 2.08 years, respectively. Duration of type 1 diabetes mellitus and donor body mass index were significantly associated with pancreas graft loss due to DWFG and graft thrombus, respectively. This characterization showed that the timing and preoperative factors associated with pancreas graft loss were significantly different for different causes of graft loss. These results may inform PTx follow-up protocols to ensure that appropriate care is based on the cause of graft loss.

Early Pancreatic Allograft Loss after Simultaneous Pancreas-Kidney Transplantation: Donor-Related Risk Factors

Early Pancreatic Allograft Loss after Simultaneous Pancreas-Kidney Transplantation: Donor-Related Risk Factors

PANCREAS EX-SITU PRESERVATION AND EVALUATION. DEVELOPMENT OF A NORMOTHERMIC MACHINE PERFUSION SYSTEM

Simultaneous kidney-pancreas transplantation remains the gold standard treatment for patients with type I diabetes and end-stage renal disease. The evolution of donor demographics requires the use of marginal donor organs including donors with extended criteria and donation after circulatory death; donor organs which are particularly sensitive to ischemia-reperfusion injury. Ex-situ normothermic perfusion (NP) is currently established in other solid organs to preserve, assess and rejuvenate donor grafts prior to transplantation. We describe our NP system based on extracorporeal machine oxygenation as a reproducible and affordable strategy to enable pre-clinical experiments in both small animal and human grafts to enable ex-situ assessment. Our NP system is established using modified paediatric extracorporeal machine oxygenation system and using low circuit perfusate volumes to allow prolonged perfusions. This system has reliably supported pancreas grafts for 6 hours maintaining normal macroscopic appearances and characteristics in human (n = 3), porcine (n = 8) and primate non-human pancreases (n = 2). This system mimics the early reperfusion period in transplantation however is readily adaptable to investigate other research objectives in ex-situ pancreas studies.

Recipient and Graft Outcomes in Simultaneous Kidney and Pancreas Transplantation With Steroid Avoidance in the United States.

Steroid avoidance in kidney transplantation has been proven noninferior. Long-term outcome data on steroid avoidance in simultaneous pancreas-kidney (SPK) remains scant. Utilizing the Scientific Registry of Transplant Recipients between 2000 and 2020, we studied all primary crossmatch negative SPK recipients (N = 5683) who received antithymocyte globulin induction and were discharged alive with functioning grafts on tacrolimus and mycophenolate ± steroid maintenance. Recipients were grouped according to steroid use into 2 groups: steroid maintenance (n = 4191) and steroid avoidance (n = 1492). Kaplan-Meier curves censored at 10 y were generated for recipient and allograft survival by steroid maintenance. Predictors for recipient and graft survival were examined using Cox Proportional Hazards. Models were adjusted for age, body mass index, ethnicity, diabetes type, human leukocyte-antigen mismatches, cold ischemia time, transplant era, preemptive transplantation, and pancreas donor risk index with the transplant center included as a random effect. Steroid avoidance gained popularity over time, accounting for over one-fourth of the studied cohort. One-year acute rejection rates by steroid avoidance were comparable for kidney (8.6% versus 9%, P = 0.783); however, the pancreas rejection rate was lower in the steroid avoidance group (7.9% versus 10%; P = 0.035). After adjustment, steroid avoidance did not influence recipient survival (lower level of confidence interval, adjusted hazard ratio, upper level of confidence interval: 0.94, 1.15, 1.39), pancreas (0.75, 0.93, 1.16), or kidney (0.95, 1.18, 1.45) death-censored survival, compared with steroid maintenance. Accounting for the recipient and graft characteristics, steroid avoidance is associated with similar recipient, pancreas, and kidney graft outcomes compared with steroid maintenance in SPK recipients after antithymocyte globulin induction with tacrolimus and mycophenolate maintenance.

343.11: New Arterial Reconstruction Technique Among Simultaneous Pancreas-Kidney (SPK) Transplantation: A Randomized Clinical Trial

Introduction: Pancreas transplant is the most physiologic therapy for the diabetic patient.Pancreas transplantation is most commonly performed in conjunction with a kidney transplant, a procedure referred to as simultaneous pancreas-kidney (SPK) transplantation. Despite over two decades of experience and the considerable refinements in the surgical techniques, the operation still carries a high morbidity. It theorized that surgical complications following SPK result from the devascularization of the pancreas allograft during the combined liver-pancreas procurement.In this study we are approaching a new arterial reconstruction technique amongst SPK aiming to reduce pancreatic manipulation hence postoperative complications. Methods: This Trial was performed in from October 2020 to December 2021 in Shiraz Transplant Center, Shiraz, Iran. Inclusion criteria was all patients over 18 years of age undergone SPK tx due to diabetic nephropathy. For venous anastomosis, the superior mesenteric vein (SMV) is clamped at the mesenteric root. After venotomy of SMV, an end-to-side anastomosis is performed from the portal vein to SMV with standard vascular anastomosis technique. then the patients rendomized for Arterial reconstruction: arterial reconstruction is performed with a Y graft anastomosis to the right common iliac artery (CIA) or, a Y graft with two short arms is selected in a bench surgery, and an extension graft from the carotid is prepared for anastomosis to the CIA. The primary outcomes were evaluatation of postoperative complications such as pancreatitis, vascular events, fistula formation, intra-abdominal bleeding, and rejection in the first six months after SPK transplantation in these two different arterial reconstruction technique. Results: A total of 30 patients were included in this study, of which 15 were in each group. The mean age of patients was 33.3 ± 6.3 years.19 patients were male and 11 patients were female. Table 1 shows demographic data between the two groups. According to results of table 2, rate of pancreatitis,vascular events and rejection was less in the Y- graft and extension technique,although this difference was not statistically significant.No mortality was observed during the study period. Cohen’s coefficient for Y graft and extension technique regarding pancreatitis, venous thrombosis,rejection was 0.5, 0.57 and 0.61, respectively which means a medium-sized effect. Conclusion: The results of our study showed that the Y- graft and extension technique reduces postoperative complications such as pancreatitis, vascular events and rejection without increasing the lenght of surgery time.

343.3: Outcomes of Primary Simultaneous Pancreas-Kidney Transplants by Induction Agent in the United States

Background: Induction immunosuppression choice for simultaneous pancreas-kidney (SPK) transplants varies widely in the United States. We examined the association between induction agents and outcomes of SPK recipients discharged on tacrolimus and mycophenolate. Methods: We used the Scientific Registry of Transplant Recipients to examine all primary SPK transplants between 2000 and 2020, excluding crossmatch positive recipients and those with other induction regimens. We grouped recipients according to induction regimen used into three groups: anti-thymocyte globulin (n=5678), alemtuzumab (n=1199) and IL-2 RA (1593). Delayed graft function, acute kidney and pancreas rejection rates were compared by type of induction. We analyzed the ten-year recipient and composite (kidney and pancreas) grafts survival using Kaplan-Meier survival function. Cox proportion hazard models were utilized to examine the association between induction type and the ten-year recipient and grafts survival. Models were adjusted for recipient age, sex, ethnicity, HLA-MM, diabetes type, dialysis dependency, cold ischemia time, local vs imported organs, PRA, steroid maintenance and PDRI. Results: Delayed graft function rate was observed in less than 6.5% of the recipients and did not differ between groups P=0.68. One-year kidney rejection rates were observed in 8.9% of the anti-thymocyte group, 9.5% of the IL-2RA group and 13% in the alemtuzumab group (p<0.001). Similarly, one-year pancreas rejection rates were observed in 9.5% of the anti-thymocyte group, 12.4% of the IL-2RA group and 14.1% in the alemtuzumab group (p<0.001). In the univariable analysis, induction type was not associated with recipient (log-rank p=0.11) or grafts survival (log-rank p=0.36). In the multivariable model for the composite grafts survival, alemtuzumab use was associated with 22% increased kidney or pancreas graft loss compared to anti-thymocyte globulin (LLCI, aHR, ULCI) (1.05, 1.22, 1.42), while IL-2RA use was not a predictor of worse grafts survival. Induction type didn’t influence recipient survival in the adjusted model. Conclusion: r-ATG use was associated with the lowest kidney and pancreas rejection rates. Compared to r-ATG, alemtuzumab but not IL-2RA was associated with worse long-term death-censored SPK grafts outcome. Our analysis supports the US national popularity of r-ATG induction in primary SPK recipients.

P16.39: Immunogenicity of the Inactivated SARS-CoV-2 Vaccine (BBIBP-CorV; Sinopharm) And Short Term Clinical Outcomes in Vaccinated Solid Organ Transplant Recipients: A Prospective Cohort Study

Introduction: Immunocompromised patients have lower seroconversion rate to Coronavirus disease 2019 (COVID-19) vaccination due to immune system dysfunction. So far, the majority of studies in this area are conducted on messenger ribonucleic acid (mRNA) based vaccines. The aim of this study is evaluation of humoral immune response and in transplant patients and short term clinical outcomes in transplant patients vaccinated with SARS-CoV-2 Vaccine (BBIBP-CorV). Methods: All patients older than 18 years old who had been transplanted more than six months prior to recruitment were included in this prospective cohort conducted in Shiraz transplant center as the largest transplant center in Asia from March to December, 2021. The patients received two doses of Sinopopharm 4 weeks apart. The immunogenicity was evaluated through assessment of antibodies against the receptor-binding domain (RBD) of SARS-CoV-2 by enzyme-linked immunosorbent assay (ELISA) method 4 weeks after the first and second dose of vaccine. The patients were followed up weekly up to six months after the second dose monthly up to six months after second dose and were evaluated for occurrence of vaccine adverse events, or getting COVID-19, hospitalization and laboratory parameters. The clinical and laboratoty data of patients was recorded and analyzed by statistical tests. Results: Totally, 921 transplant patients (665 kidney transplantation, 221 liver transplantation, 28 simultaneous pancreas kidney (SPK) and 7 heart transplant recipients). 115 (12.5%) and 239 (26%) patients had acceptable anti S-RBD IgG levels 4 weeks after the first and second dose, respectively. After omitting COVID19 cases with positive PCR test within 6 months before vaccination, 104 (12.6%) and 211 (25.5%) patients had acceptable anti S-RBD level 4 weeks after the first and second dose. Totally, 80 patients (8.68%) got infected with COVID-19 after vaccination.45 (4.9%) patients were admitted in the hospital due to COVID-19 after receiving the second dose of vaccine. None of the patients died during 6 months follow up period. 24 (10.9%) ones developed liver enzyme elevation Also, rise in serum creatinine was observed in 86 (13.5%) kidney transplant patients. Two of SOT recipients experienced biopsy proven rejection which managed by high dose of corticosteroid without any graft loss episodes. Conclusion: The results of our study showed that humoral response rate to Sinopharm vaccine was low in transplant patients. Short time from transplant was only effective factor on low seroconversion rate in transplant patients due to the high dose of immunosuppressive medications in this time frame. It is recommended that the third dose of vaccine, particularly from a different vaccine platform from the inactivated vaccine be administered in transplant patients.

343.4: Pancreas Transplant Outcomes With No Early Graft Loss at A Single Institution

Introduction: The reported 3-month graft failure rate for pancreas allograft remains high ranging from 7-22%. We report outcomes and experience from a single institution with no technical graft loss. Method: A retrospective chart review was conducted of patients who underwent pancreas transplant +/- a kidney transplant from 2012-2021 with a maximum follow-up of five years. Information on pancreas and kidney graft failure was obtained and defined by current 2019 Organ Procurement and Transplantation Network (OPTN) criteria. Results: There were a total 74 patients included. The average age was 47.2 (+/- 9.97) with an average duration of diabetes of 22 years. 35.1% of patients were White, 40.5% Black and 24.3% other. 25% of patients identified as Hispanic. 70% of patients were male and 30% female. 65% of patients had type I diabetes and 35% type II diabetes. Most patients underwent simultaneous pancreas kidney (SPK) transplant (92%). 5.4% had pancreas transplant after kidney (PAK) and 2.7% had a pancreas transplant alone (PTA). The 3-month pancreas and kidney allograft survival was 100%. The 1-year survival for both pancreas and kidney were 97%. 5-year survival for pancreas allograft was 90.4% and 91.8% for kidney allograft. There was no pancreas graft failure due to vascular thrombosis or technical complications. Reasons for failure (n = 8) included post-transplant lymphoproliferative disorder (PTLD), vascular compromise after one year, weight gain with diagnosis of type II diabetes after transplantation for type I diabetes (n= 2), death due to other causes such as burn, graft vs. host disease, chronic obstructive pulmonary disease complications and lung cancer. The causes for kidney graft failure (n=5) included the previous deaths mentioned and PTLD. Conclusion: We report improved survival after pancreas transplantation with no early vascular thrombosis or technical complications and good pancreas and kidney allograft survival due to optimization of technique in addition to protocolized pre- and post-operative management protocol.

214.5: Long-term Outcomes in Primary Simultaneous Kidney and Pancreas Recipients Under Steroid Avoidance in the United States

Background: Steroid avoidance in kidney transplantation has been proven non-inferior. Data on steroid avoidance in simultaneous pancreas-kidney (SPK) is scant. Methods: We utilized the Scientific Registry of Transplant Recipients (SRTR) between 2000 and 2020 we studied all primary crossmatch negative SPK recipients (N=5683) who received anti-thymocyte globulin for induction and were discharged alive on tacrolimus and mycophenolate with or without steroid maintenance. Recipients were grouped according to steroid use into two groups: steroid maintenance n=4191 and steroid avoidance n=1492. Kaplan-Meier curves with generated for Recipient and allografts survival according to steroid maintenance censored at 10 years. Predictors for recipient and grafts survival were examined using Cox proportional Hazards. Models were adjusted for age, BMI, ethnicity, diabetes type, HLA-antigen mismatches, cold ischemia time, transplant era, preemptive transplantation, and PDRI with the transplant center included as a random effect. Results: Steroid avoidance gained popularity over the years, accounting for over one fourth of the studied cohort. One-year acute rejection rates by steroid avoidance were comparable for kidney (8.6 vs. 9%, P= 0.783, however pancreas rejection rate was lower in the steroid avoidance group (7.9 vs. 10%. P=0.035). In the Kaplan-Meier analysis for the pancreas death-censored graft survival (DCGS), steroid avoidance was associated with better pancreas graft survival (log-rank p =0.006). The kidney DCGS did not vary between groups (log-rank p=0.233). In the multivariable models, steroid avoidance did not influence recipient (LLCI, aHR, ULCI) (0.94, 1.15,1.39), death-censored pancreas graft survival (0.75, 0.93, 1.16) or kidney (0.95, 1.18, 1.45) compared to recipients on steroid maintenance. Conclusion: After multivariable adjustment for recipient and grafts characteristics, steroid avoidance is associated with similar patient, pancreas and kidney grafts outcomes when compared with steroid maintenance in SPK recipients following r-ATG induction and tacrolimus plus mycophenolate maintenance. The data reported here have been supplied by the Hennepin Healthcare Research Institute (HHRI) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.

343.7: COVID-19 and Allograft Damage After Simultaneous Pancreas And Kidney Transplantation: Clinical Case Series And Literature Review

Introduction: The risk for morbidity and mortality from coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), is high in transplant recipients due to the continued immunosuppression regimen for allograft maintenance. While SARS-CoV-2 primarily affects the lungs and causes pulmonary sequelae, evidence suggests that infection by the virus affects other organ systems as well. Simultaneous pancreas-kidney (SPK) transplantation is a treatment for patients with insulin-dependent diabetes and end-stage renal failure. Management of COVID-19 is especially challenging in patients who received SPK transplantation due to the complex interaction between the viral pathogenesis, pancreas and kidney allografts, and immunosuppressive therapies. Therefore, examining the clinical management and recovery process of allograft damage in post-SPK transplant patients who contacted COVID-19 could be valuable in establishing optimal treatment guidelines for this vulnerable population. Methods: We present a series of patients who contacted COVID-19 and developed allograft damage after receiving SPK transplantation at our institution. The following information was retrieved and collated: demographics, baseline health following transplantation, clinical management of COVID-19 infection and allograft damage. Results: Out of 10 post-SPK transplant patients who tested positive for COVID-19, 5 patients (50%) also developed elevation of amylase and/or lipase levels 3 times the upper limit of normal. The average AlloSure level of these 5 patients was 5.67% at the time of pancreatic damage. One patient contacted COVID-19 after being admitted for acute rejection and inflammation of the pancreas, and recovered after receiving remdisivir, dexamethasone, plasmapheresis, and high dose prednisone with aggressive diuresis. The other patient was diagnosed with pancreatitis and acute kidney injury on admission and had symptomatic improvements after receiving thymoglobulin induction, IVIG, and rituximab. The patient subsequently contacted COVID-19 after discharge and fully recovered after receiving Bamlanivimab infusion, which occurred concurrently with a precipitous decline in amylase and lipase levels. The remaining 3 patients did not meet the criteria for acute pancreatitis, and they recovered after receiving tixagevimab with cilgavimab, remdisivir with dexamethasone, and Bamlanivimab infusion, respectively, along with supportive treatments. Conclusion: Damage to the allograft via immunological processes and infectious agents is a recurring concern for patients who received SPK transplantation. Notwithstanding the clinical overlap of COVID-19 infection and allograft damage in the reported patients, it is still unclear if COVID-19 infection directly elicits damage. Further research is required to clarify the relationship between these two phenomena and establish an optimal treatment guideline.

234.8: Donor-Derived Cell-Free DNA for Rejection Surveillance in Simultaneous Pancreas Kidney Transplantation

234.8: Donor-Derived Cell-Free DNA for Rejection Surveillance in Simultaneous Pancreas Kidney Transplantation

P8.031: Outcome of Simultaneous Pancreas Kidney Transplantation A Single Center Experience

Introduction: Simultaneous simultaneous pancreas-kidney (SPK) transplantation is one of the treatment options for type 1 diabetes mellitus (T1DM) patients with chronic kidney disease stage 5. The SPKT outcomes are reported to be excellent with a 5 year patient, kidney and pancreas graft survival of 88%, 77% and 69% respectively. Here, we present data regarding outcome of the SPKT done at our institution. Method: We studied patients who underwent SPKT in our institution. 11 T1DM patients who were CKD-5 underwent SPKT from 2014 to 2022. Their graft function and complications were analysed. Results: A total of 12 patients were studied. 50 % were males and 50% were females. Mean age at diagnosis was 14 ± 4 years. Mean age at transplantation was 32 ± 6 years. Mean hemodialysis (HD) vintage was 22 ± 14 months. Mean age of donor was 31 ± 10 years. Induction was with Basiliximab in 1 patient, Alemtuzumab in 5 patients and ATG in 6 patients. Maintenance immunosuppression was tacrolimus and mycophenolate in 8 patients; and, tacrolimus, mycophenolate and everolimus in 2 patients Mean duration of hospital stay was 30 ± 18 days. Mean graft kidney function at 1 month was 1.38 ± 0.48 mg/dl. Mean graft kidney function at 6 months was 1.30 ± 0.47 mg/dl. At 1 year, one patient had severe renal graft dysfunction requiring HD. Among the other 10 patients who completed one year, mean kidney graft function at 1 year was 1.25 ± 0.23 mg/dl. Three (25%) patients had renal allograft loss with need for initiation of HD after 30, 21 and 6 months. Two patients with renal allograft loss required insulin after 19 and 25 months. Three (25%) patients had delayed graft function. Five (41.7%) patients had renal allograft rejection at 1 month. Among the five, three had another episode of rejection at 17, 11 and 4 months. Three (25%) patients had suspected pancreatic graft rejection at POD 13, 13 and 14, which resolved with intravenous steroids. Eight (66.6%) patients had infections in the first year following transplant which included urosepsis, LRTI, tuberculosis, varicella, CMV, cellulitis, periodontal abscess, dental caries and esophagial candidiasis. Seven (58.3%) had surgical complications including pseudo aneurysm of graft pancreas, urinoma, perinephric hematoma, abdominal bleed and DIC, jejujno-jejunal anastomotic site bleed, kinked renal vein requiring re-exploration, graft pancreas fat necrosis with impending GB rupture and peritonitis, and splenic vein thrombosis requiring re-exploration. Other complications noted were incisional hernia, subacute intestinal obstruction, bilateral femoral head avascular necrosis and acute myeloid leukemia. Conclusion: The graft survival and outcomes in our institution is comparable to that of international standards. Surgical complications were noted to be higher compared to renal transplantation. SPK remains to be treatment of choice in T1DM patients with ESRD.

214.6: Outcomes in Mild Obese Recipients With Diabetes Mellitus Type 2 That Received Simultaneous Kidney Pancreas Transplant

214.6: Outcomes in Mild Obese Recipients With Diabetes Mellitus Type 2 That Received Simultaneous Kidney Pancreas Transplant

P12.17: Simultaneous Pancreas-Kidney Transplantation in One Russian Transplant Center

P12.17: Simultaneous Pancreas-Kidney Transplantation in One Russian Transplant Center

343.6: Outcomes of Simultaneous Kidney-Pancreas Transplantation in Patients With Type-1 and Type-2 Diabetes Mellitus

Introduction: Advantages for type-2 diabetes mellitus (T2DM) patients receiving simultaneous kidney-pancreas transplantation (SKPT) as compared to kidney transplantation are shorter waiting times and availability of better-quality organs. UNOS approved SKPT for T2DM in 2014. We listed patients with T2DM and ESRD for SKPT with the following criteria: (1) age < 55 years, (2) insulin requirement ≤ 1 unit/kg body weight, (3) BMI ≤ 32 kg/m2. The aim of this study was to measure the change in volume of SPKT and compare outcomes between SKPT T1DM and T2DM recipients. Method: From Feb 2010 to Dec 2021, 62 T1DM and 36 T2DM SKPT recipients were studied. BMI, c-peptide, HbA1c, and e-GFR were evaluated pre-transplant and post-transplant until 1-year. Outcomes included volume of SKPT pre-and post- UNOS approval of SKPT for T2DM, complications, death-censored 5-year kidney and pancreas graft survival, and 5-year patient survival. Results: Among 98 SKPT, 18 (T1DM) were done before and 80 (44 T1DM and 36 T2DM) after the UNOS approval of SKPT in T2DM, translating to an increase in SKPT from 3.6/year to 11.4/year (216.7% increase) (Figure 1). T2DM patients were older, gained weight post-transplantation, and had higher BMI and e-GFR at 1-year post-transplant (Table 1). There were no differences in complications and graft and patient survival (Figure 2). Conclusions: UNOS approval of SKPT for T2DM led to an increase in SKPT with no differences in graft or patient survival between T1DM and T2DM patients. Weight gain should be carefully monitored and managed post-transplant in SKPT T2DM recipients.

Salvage of Graft Pancreas in a Simultaneous Pancreas-kidney Transplant Recipient With Splenic Artery Thrombosis, Infected Walled-off Necrosis, and Stenting of Y Arterial Graft Stenosis.

Salvage of Graft Pancreas in a Simultaneous Pancreas-kidney Transplant Recipient With Splenic Artery Thrombosis, Infected Walled-off Necrosis, and Stenting of Y Arterial Graft Stenosis.

Pretransplant Psoas Muscle Cross-Sectional Area and Postkidney Transplant Outcomes

Sarcopenia is associated with adverse outcomes in end-stage kidney disease. We evaluated if pretransplant sarcopenia affects posttransplant outcomes in kidney transplant (KT) recipients. In this single-center retrospective study of adult patients with end-stage kidney disease, we analyzed the association between pre-KT psoas muscle cross-sectional area and critical posttransplant outcomes of decline in estimated glomerular filtration rate (eGFR), graft loss, rehospitalization, and mortality using Cox proportional hazard model adjusted for age, sex, and race. Pre-KT abdomen and pelvic computed tomography scans performed during evaluation for KT eligibility were available for 573 KT recipients. Of these, 465 KT recipients received kidney alone transplant, 71 received simultaneous liver kidney transplant (SLK), and 37 received simultaneous pancreas kidney transplant (SPK). Patients were 49 (SD, 13) years old, 16% Black, and 60% men. For kidney alone transplant recipients, a higher psoas muscle cross-sectional area was associated with a shorter length of hospitalization (β coefficient=-0.003; 95% CI, -0.005 to -0.0007). Conversely, pre-KT psoas muscle cross-sectional area did not predict decline in eGFR, graft loss, mortality, or early rehospitalization. For SLK recipients, psoas muscle cross-sectional area did not predict any of the priori outcomes. For SPK recipients, higher pretransplant psoas muscle cross-sectional area predicted a longer length of hospitalization (β coefficient=0.03; 95% CI, 0.01-0.05). There was no association between psoas muscle cross-sectional area and other outcomes assessed. Pretransplant psoas muscle cross-sectional areas are not predictive of post-transplant decline in eGFR, graft loss, rehospitalization or mortality in kidney alone, SPK, or SLK transplants.

Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study

Among hospital-acquired infections, surgical site infections (SSIs) are frequent. SSI in the early post-transplant course poses a relevant threat to transplant recipients. To determine incidence, risk factors for SSI and its association with post-transplant outcomes and pancreas transplant (P-Tx) recipients. Adult simultaneous kidney-pancreas transplantation (SPK-T) and P-Tx recipients with a follow-up of at least 90 days were identified in the Swiss Transplant Cohort Study (STCS) dataset. Except for the categorization of SSIs according to Centers for Disease Control and Prevention (CDC) criteria, all other data were prospectively collected. Risk factors for SSI were investigated with logistic regression. A Weibull accelerated failure-time model was applied to address the impact of SSI on length of stay, correcting for transplant-related complications and delayed graft function. Of 130 transplant recipients, 108 SPK-Tx and 22 P-Tx, 18 (14%) individuals developed SSI within the first 90 days after transplantation. Deep incisional (seven, 38.9%) and organ/space infections (eight, 44.4%) predominated. In the majority of SSIs (11, 61.1%; two SSIs with simultaneous identification of fungal pathogens) bacteria were detected with Enterococcus spp. being most frequent. The median duration of hospitalization after transplantation was significantly longer in recipients with SSI (median: 26 days; interquartile range (IQR): 19-44) than in patients without SSI (median: 17 days; IQR: 12-25; P=0.002). In multivariate analysis, SSI was significantly associated with increased length of stay and prolonged the duration of hospitalization by 36% (95% confidence interval: 4-79). SSI after SPK-Tx and P-Tx occurred at a frequency of 14%. Among pathogens, Enterococcus spp. predominated. SSI was independently associated with a longer hospitalization after transplantation.