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. 2023 May 16;408(1):196.
doi: 10.1007/s00423-023-02876-7.

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

Tommaso Giuliani  1   2 , Javier Maupoey Ibáñez  1 , Eva Montalvá-Orón  1   3 , Andrea Boscà Robledo  1 , Cristina Martínez Chicote  1 , Ana Hernando Sanz  1 , Cristina Ballester Ibañez  1 , David Calatayud Mizrahi  1 , Isabel Beneyto Castelló  4 , Juan Francisco Merino Torres  5 , Rafael López Andújar  6   7
Affiliations

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

Tommaso Giuliani et al. Langenbecks Arch Surg. .

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.

Keywords: Average complication burden; Complications; Comprehensive Complication index; Kidney transplantation; Pancreas transplantation.

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References

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