Multivariate analysis of complications after simultaneous pancreas and kidney transplantation.
OBJECTIVE
Identification of factors that have an impact on postoperative complications after simultaneous pancreas and kidney transplantation (SPKTx) could help overcome limitations of this kind of treatment.


METHODS
Postoperative complications among 112 SPKTx recipients were divided into 3 groups: related to transplanted pancreas (n = 66), related to transplanted kidney (n = 23) and general surgical complications (n = 31) 120 refers to complications among 112 recipients. According to the modified Clavien-Dindo scale, complications were classified according to their severity for each group. Risk factors for complication development related to donor, recipient, surgical technique, and immunosuppression were included to establish the multivariable model using logistic regression.


RESULTS
Multiple regression analysis showed the following independent factors influenced mortal complications due to transplanted pancreas: age of donor (OR, 1.07; P < .04), duration of vascular pancreas anastomosis above 35 minutes (OR, 3.94; P < .04) and duration of recipient dialysis above 24 months before transplantation (OR, 0.14; P < .01). Area under receiver operating characteristic curve for this model was 0.8.


CONCLUSIONS
To improve results, the following modification of identified risk factors should be assumed: selection of donor in term of age, shortening of the second warm ischemia time, and adjustment of the waiting list to avoid prolongation of recipient dialysis before SPKTx.
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland. Electronic address: tadeusz.grochowiecki@wum.edu.pl.
T
T
Grochowiecki
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland.
Z
Z
Gałązka
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland.
K
K
Madej
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland.
S
S
Frunze
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland.
S
S
Nazarewski
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland.
T
T
Jakimowicz
Department of Immunology, Transplantology and Internal Diseases, Medical University of Warsaw, Poland.
L
L
Paczek
Department of Transplantation Medicine and Nephrology, Medical University of Warsaw, Poland.
M
M
Durlik
Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, Poland.
J
J
Szmidt
D000328:Adult; D000367:Age Factors; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D007668:Kidney; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000009:adverse effects*; D011183:Postoperative Complications / Q000453:epidemiology*; D012044:Regression Analysis; D006435:Renal Dialysis / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data; D014850:Waiting Lists; D055815:Young Adult
D007166:Immunosuppressive Agents