Influence of dialysis modality on complications and patient and graft survival after pancreas-kidney transplantation.
BACKGROUND
We investigated whether hemodialysis or peritoneal dialysis prior to pancreas-kidney transplantation was a risk factor for the development of surgical complications, recipient mortality, or graft loss.


METHODS
From March 1995 to December 2006, 90 patients with type 1 diabetes underwent pancreas transplantation. Dialysis before transplantation was provides to 81 patients. We compared outcomes of recipients classified as two groups: (A) hemodialysis (n = 49, 60.5%) versus (B) peritoneal dialysis (n = 32, 39.5%) groups.


RESULTS
Donor and recipient characteristics were similar in both groups. Enteric drainage was more frequently used in the hemodialysis group and bladder drainage in the peritoneal dialysis group (P < .05). The rate of intra-abdominal infections was similar in both groups: 10 patients (20.4%) in the hemodialysis group and 9 patients (28.1%) in the peritoneal dialysis group (P = NS). The incidence of enteric or bladder leakage was slightly higher in the peritoneal dialysis group (5 cases, 15.6% vs 4 cases, 8.2% in the hemodialysis group; P = NS). The rate of reoperations was also slightly higher in the peritoneal dialysis group B (15 cases, 46.9% vs 14 cases, 28.6% in the hemodialysis group; P = .07). Pancreas transplantectomy was significantly greater in the peritoneal dialysis (9 cases; 28.1%) than the hemodialysis group (5 cases; 10.2%; P < .05). The actuarial 3-year patient survival was 95.9% in the hemodialysis group and 93.4% in the peritoneal dialysis group (P = NS); actuarial 3-year pancreas graft survival was 79.3% in the hemodialysis group and 68.3% in the peritoneal dialysis group (P = NS).


CONCLUSIONS
We noted an insignificantly greater rate of reoperations but significantly higher incidence of pancreas transplantectomy in the peritoneal dialysis group; however, patient and pancreas graft survivals were similar in both study groups.
Jiménez
C
C
Servicio de Cirugía General, Ap Digestivo y Trasplante de Organos Abdominales, Hospital Universitario Doce de Octubre, Madrid, Spain. carlos.jimenez@inforboe.es
Manrique
A
A
Morales
J M
JM
Andrés
A
A
Ortuño
T
T
Abradelo
M
M
Gimeno
A
A
Calvo
J
J
Cambra
F
F
Sterup
R L
RL
Moreno
E
E
D000328:Adult; D005260:Female; D006801:Humans; D007239:Infections / Q000453:epidemiology; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality / Q000502:physiology; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality / Q000502:physiology; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome