title: Influence of simultaneous pancreas and preemptive kidney transplantation on severity of postoperative complications.
abstract: BACKGROUND
  Simultaneous pancreas and preemptive kidney transplantation (SPpreKT) seems to be the optimal treatment for the patients with diabetes type 1 who are progressing to end-stage renal disease. On the other hand, surgical complications with a high rate of relaparatomy are a limiting factor in pancreas transplantation.
  
  
  OBJECTIVE
  Comparison of severity of surgical complications was performed between a group of preemptive (SPpreKT group) and nonpreemptive recipients of SPKT (SPKT group).
  
  
  METHODS
  Between 1988 and 2010, we performed 112 SPKTs including 25 preemptive recipients (22.3%). The SPKT Group included 87 recipients (77.7%). The severity of complications was classified according to a modified Clavien scale: grade I, no complication; grade II, drug therapy; grade IIIA, invasive intervention not requiring general anesthesia; grade IIIB, invasive intervention requiring general anesthesia; grade IVA, graft failure; and grade IVB, death.
  
  
  RESULTS
  Among the SPpreKT group, 64% of recipients were free from postoperative complications compared with 40.3% of the SPKT group (P<.01). Among the SPKT group, 52 recipients (59.7%) developed 58 postoperative complications, including 15 (17.3%) deaths due to graft pancreatitis (80%) or pancreatic fistula (20%). Among the SPpreKT group, 9 recipients developed 9 complications. None of the preemptively transplanted group subjects experienced a lethal complication. Among the SPpreKT group, the most severe complication was graft pancreatitis leading to graft removal in 2 recipients.
  
  
  CONCLUSIONS
  Recipients of preemptive SPKT developed significantly fewer postoperative complications, especially deaths. However the rates of mild (II, IIIA) and moderate (IIIB) complications as well as graft failures (IVA) were similar to the nonpreemptive group.
authors: Department of General, Vascular, and Transplant Surgery, Warsaw Medical University, and Department of Gastrointestinal Surgery and Transplantology, Central Clinical Hospital of Ministry of Foreign Affairs, Warsaw, Poland. tadeusz.grochowiecki@wum.edu.pl
authors: T
authors: T
authors: Grochowiecki
authors: Z
authors: Z
authors: Gałazka
authors: S
authors: S
authors: Frunze
authors: S
authors: S
authors: Nazarewski
authors: T
authors: T
authors: Jakimowicz
authors: L
authors: L
authors: Paczek
authors: M
authors: M
authors: Durlik
authors: M
authors: M
authors: Lao
authors: J
authors: J
authors: Szmidt
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery; D003928:Diabetic Nephropathies / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000379:methods*; D011044:Poland; D011183:Postoperative Complications / Q000209:etiology* / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index