Analysis of early readmissions after combined pancreas-kidney transplantation

Abstract

Combined pancreas-kidney transplantation (PKT) has become generally accepted as an effective treatment option, but controversy exists regarding the early morbidity rate of the procedure. To address this issue, we retrospectively analyzed all readmissions occurring in the first 3 months after PKT. Over a 5-year period, we performed 98 PKTs with bladder drainage. The mean recipient age was 36.6 years, with a mean pretransplant duration of diabetes of 23.5 years. All patients received quadruple immunosuppression with antilymphocyte induction therapy. The mean length of initial hospital stay was 20 days. One hundred forty-five readmissions occurred in 73 patients (74.5%), with the initial readmission occurring at a mean of 8.5 days after hospital dismissal and 28 days after PKT. Twenty-five patients (25.5%) had no readmissions, 35 (36%) had one readmission, 17 (17%) had two readmissions, and the remaining 21 patients (21.5%) had three or more readmissions in the first 3 months. The mean number of readmissions was 1.5 per patient. Forty-seven patients (48%) were readmitted within 1 week, and all but one initial readmission occurred within 1 month of hospital dismissal. Causes of readmission included rejection (51), infection (32), pancreas-specific morbidity (such as dehydration, hematuria, or pancreatitis; 50), and miscellaneous causes (12). Thirteen patients (13%) underwent reoperation during readmission. The mean length of hospital stay during readmission was 7.6 days. The mean total length of hospitalization in the first 3 months after PKT was 31 days. Over the span of 5 years, no changes have occurred either in the incidence, timing, causes, or duration of readmissions. The patient survival rate is 96%, the kidney graft survival rate is 90%, and the pancreas graft survival rate is 88% after a mean follow-up of 2.6 years. Mean rehabilitation time (return to work or normal activity) after PKT was 4.0 months. In conclusion, PKT is associated with a fixed morbidity characterized by early readmission (within 1 week) in nearly half of patients and pancreas-specific morbidity as the cause in 35% of readmissions. During evaluation, prospective candidates should be counseled regarding the unique morbidity of PKT. Successful management strategies must emphasize the intensity of early follow-up and recognize the propensity toward immunologic, metabolic, exocrine, and urologic side effects.