title: Influence of surgical complications on kidney graft survival in recipients of simultaneous pancreas kidney transplantation.
abstract: OBJECTIVE
  Simultaneous pancreas-kidney transplantation is the gold standard treatment for patients with end-stage renal failure secondary to insulin-dependent diabetes mellitus. This kind of transplantation is a complex operation associated with a high incidence of surgical complications and mortality risk which could influence graft survival. The aim of this study was to establish the influence of different grades of postoperative complications, classified according to Clavien-Dindo, on the rate of kidney graft loss.
  
  
  METHODS
  We performed an observational retrospective review of all simultaneous transplantations performed between February 1989 and May 2012. Factors examined were related to recipient and donor characteristics, surgical procedures, and postoperative outcomes. For this purpose, Kaplan-Meier analyses and Cox-Regression tests are used.
  
  
  RESULTS
  One hundred thirty-nine transplantations were performed. Complications grades I, II, and IIIa were experienced in 81 (58.3%) patients, and grades IIIb and IVa-b in 55 (39.6%). Multivariate analysis showed an influence of panel reactive antibody (hazard ratio [HR]: 10.79; P = .003), incidence of acute rejection (HR: 2.55; P = .03), and complications grouped into grades IIIb and IVa-b (HR: 3.63; P = .02). Kaplan Meier analysis showed worse kidney graft survival rate in groups grades IIIb and IVa-b compared to grades I, II, and IIIa (86.6% vs 98.7% at 1 year and 81.8% vs 97.3% at 5 years; P = .001).
  
  
  CONCLUSIONS
  Despite being the gold standard treatment for these patients, pancreas and kidney transplantations have numerous complications which could influence the prognosis of graft kidney survival.
authors: Department of Urology, University Hospital of Reina Sofia, Maimónides Institute of Biomedical Research (IMIBIC), Córdoba, Spain. Electronic address: jpcamposhdez@hotmail.com.
authors: J P
authors: JP
authors: Campos Hernández
authors: Department of Urology, University Hospital of Reina Sofia, Maimónides Institute of Biomedical Research (IMIBIC), Córdoba, Spain.
authors: E
authors: E
authors: Gómez Gómez
authors: Department of Urology, University Hospital of Reina Sofia, Maimónides Institute of Biomedical Research (IMIBIC), Córdoba, Spain.
authors: J
authors: J
authors: Carrasco Valiente
authors: Department of Urology, University Hospital of Reina Sofia, Maimónides Institute of Biomedical Research (IMIBIC), Córdoba, Spain.
authors: F J
authors: FJ
authors: Márquez López
authors: Department of Urology, University Hospital of Reina Sofia, Maimónides Institute of Biomedical Research (IMIBIC), Córdoba, Spain.
authors: J
authors: J
authors: Ruiz García
authors: Department of Urology, University Hospital of Reina Sofia, Maimónides Institute of Biomedical Research (IMIBIC), Córdoba, Spain.
authors: F J
authors: FJ
authors: Anglada Curado
authors: Department of Urology, University Hospital of Reina Sofia, Maimónides Institute of Biomedical Research (IMIBIC), Córdoba, Spain.
authors: R
authors: R
authors: Prieto Castro
authors: Department of Surgery, University Hospital of Reina Sofia, Córdoba, Spain.
authors: J
authors: J
authors: Ruiz Rabelo
authors: Department of Nephrology, University Hospital of Reina Sofia, Córdoba, Spain.
authors: M L
authors: ML
authors: Navarro Cabello
authors: Department of Urology, University Hospital of Reina Sofia, Maimónides Institute of Biomedical Research (IMIBIC), Córdoba, Spain.
authors: M J
authors: MJ
authors: Requena Tapia
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome