Simultaneous pancreas-kidney transplantation: which graft warns the most?

Fecha de publicación: 16/05/2023 Fecha Ahead of Print: 16/05/2023

Autores de IIS La Fe

• Tommaso Giuliani

  Autor

• Javier Maupoey Ibáñez

  Autor

• Eva María Montalvá Orón

  Autor

• Andrea Boscà Robledo

  Autor

• Cristina Martínez Chicote

  Autor

• Ana Hernando Sanz

  Autor

• Cristina Ballester Ibáñez

  Autor

• David Calatayud Mizrahi

  Autor

• Isabel Beneyto Castello

  Autor

• Juan Francisco Merino Torres

  Autor

• Rafael López Andújar

  Autor

Grupos

• Hepatología, Cirugia Hepatobiliopancreática y Trasplantes

  

  Leader

  Marina Berenguer Haym

• Unidad Mixta de Investigación en Endocrinología, Nutrición y Dietética clínica

  Leader

  Juan Francisco Merino Torres

Abstract

BACKGROUND: Simultaneous pancreas-kidney transplantation (SPK) is still characterized by high rates of postoperative complications. This study aims to offer an in-depth characterization of early, medium-term, and late complications following SPK to derive insights for postoperative management and follow-up. METHODS: Consecutive SPK transplantations were analysed. Pancreatic graft (P-graft)- and kidney graft (K-graft)-related complications were analysed separately. The global postoperative course was assessed in three timeframes (early, medium-term, and late) using the comprehensive complication index (CCI). Predictors of complications and early graft loss were explored. RESULTS: Complications occurred in 61.2% of patients, and the 90-day mortality was 3.9%. The overall burden of complications was significantly high during admission (CCI 22.4 ± 21.1) and decreased gradually afterwards. P-graft-related complications burdened the most in the early postoperative course (CCI 11.6 ± 13.8); postoperative ileus and perigraft fluid collection were the most frequent complications, and pseudoaneurysms, haemorrhages, and bowel leaks were the major concerns. K-related complications were milder but represented the largest proportion of the CCI in the late postoperative timeframe (CCI 7.6 ± 13.6). No predictors of P-graft- or K-graft-related complications were found. CONCLUSION: Pancreas graft-related complications represent the largest part of the clinical burden in the early postoperative timeframe but are negligible after 3 months. Kidney grafts have a relevant impact in the long term. The multidisciplinary approach to SPK recipients should be driven based on all graft-specific complications and tailored on a time-dependent basis.

© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.

Keywords

• Average complication burden; Complications; Comprehensive Complication index; Kidney transplantation; Pancreas transplantation