Influence of donor- and recipient-specific factors on the postoperative course after combined pancreas-kidney transplantation.
BACKGROUND
Simultaneous pancreas-kidney (SPK) transplantation is state-of-the-art therapy for patients with type-1 diabetes mellitus and end-stage renal failure. Improvement of long-term organ function and long-term survival after transplantation is the main focus of current research, but improvement of the early postoperative course is very important for the patient. Pancreas transplantation is associated with postoperative complications. We defined and identified donor- and recipient-specific factors related to postoperative complications.


METHODS
We carried out 210 SPKs from April 1995 to December 2007. The early postoperative course until first discharge from hospital was analyzed. Complications (pancreas-specific and surgical) were revisited. Donor-specific factors such as sex, age, body mass index (BMI), laboratory values, catecholamine administration, time in the intensive care unit, preprocurement blood substitution, and asystolic periods, as well as factors related to the organ donation procedure, were assessed. Recipient-specific factors such as age, sex, BMI, and blood group were correlated with the prevalence of complications and postoperative outcome. Donor-specific risk factors correlating with postoperative complications included donor age, BMI, and blood transfusion in the donor before organ donation.


RESULTS
Graft preservation with histidine-tryptophan-ketoglutarate perfusion solution was related to a significantly higher number of surgical complications.When analyzing recipient-specific factors, pre-existing cardiac diseases influenced the prevalence of postoperative complications. The duration of the transplantation procedure was associated with significantly more complications. The anastomosis time was not significantly related to an increased prevalence of complications. The choice of immunosuppression had a significant effect on pancreas-specific complications, demonstrating that antithymocyte globulin instead of daclizumab had a negative effect. Initial immunosuppression with tacrolimus combined with mycophenolate mofetil (MMF) caused significantly fewer pancreas-related complications in comparison with tacrolimus combined with rapamycin as well as compared with cyclosporine combined with MMF. A high level of C-reactive protein within the first 7 days after transplantation was significantly related to an increased prevalence of complications.


CONCLUSIONS
Early postoperative complications after combined pancreas-kidney transplantation have a considerable effect on short- and long-term outcomes. Several statistically relevant factors related to pancreas- or surgery-associated complications could be identified. These data may help to improve early outcome after SPK by consideration of relevant risk factors when choosing an organ and a recipient for transplantation.
Fellmer
Peter Thomas
PT
Department of General, Visceral- and Transplant Surgery, Charité Campus Virchow, Berlin, Germany.
Pascher
Andreas
A
Kahl
Andreas
A
Ulrich
Frank
F
Lanzenberger
Katharina
K
Schnell
Konstanze
K
Jonas
Sven
S
Tullius
Stefan G
SG
Neuhaus
Peter
P
Pratschke
Johann
J
D000328:Adult; D000367:Age Factors; D015992:Body Mass Index; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis* / Q000401:mortality; D011300:Preoperative Care / Q000379:methods; D011336:Probability; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D014019:Tissue Donors; D014021:Tissue Preservation / Q000379:methods; D055815:Young Adult