title: Pancreas-Kidney transplantation: Impact of dialysis modality on the outcome.
abstract: It remains controversial whether dialysis modality prior to SPKT (simultaneous pancreas-kidney transplantation) affects the outcome. We analyzed outcomes in type 1 diabetic patients undergoing SPKT, comparing peritoneal dialysis (PD) and hemodialysis (HD) groups: 119 had been on HD; 39 on PD. They were comparable except regarding dialysis time, higher in HD patients (30 ± 23 vs. 21 ± 15 months, P = 0.003). Thrombosis-driven relaparotomy was more frequent in PD patients (12.8% vs. 1.7%, P = 0.014). Pancreas loss due to infection was higher in PD patients (12.8% vs. 3.4%, P = 0.042). Thrombosis-related kidney loss was more frequent in PD patients (5.1%, vs. 0% in HD patients, P = 0.058). Thirteen deaths occurred, more within the PD group (17.9% vs. 5%; P = 0.011), being infection the leading cause (13.5%, vs. 1.7% in HD patients, P = 0.010). Patient survival was inferior in PD patients. Besides PD, cardiovascular disease and graft failure were independent predictors of patient death. In conclusion, PD patients more frequently complicated with intra-abominal infection leading to pancreatic loss and with renal thrombosis, with adverse impact on survival. As a PD first strategy in end-stage renal disease patients is generally associated with good outcomes, these gloomier results after SPKT urge for careful adjustment of infection and thrombosis prophylactic protocols in PD patients.
authors: Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.|Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors: La Salete
authors: LS
authors: Martins
authors: Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.
authors: Jorge
authors: J
authors: Malheiro
authors: Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.|Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors: Sofia
authors: S
authors: Pedroso
authors: Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.|Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors: Manuela
authors: M
authors: Almeida
authors: Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors: Leonidio
authors: L
authors: Dias
authors: Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.|Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors: António C
authors: AC
authors: Henriques
authors: Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Surgery Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors: Donzília
authors: D
authors: Silva
authors: Transplantation Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Surgery Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors: José
authors: J
authors: Davide
authors: Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.
authors: António
authors: A
authors: Cabrita
authors: Cellular and Molecular Nephrology Laboratory, Division of Nephrology, University of São Paulo, São Paulo, Brazil.
authors: Irene L
authors: IL
authors: Noronha
authors: Nephrology Department, Hospital Santo António, Centro Hospitalar do Porto, Porto, Portugal.|Unit for Multidisciplinary Research in Biomedicine, Institute of Biomedical Sciences Abel Salazar and University Hospital de Santo António, University of Porto, Porto, Portugal.
authors: Anabela
authors: A
authors: Rodrigues
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods / Q000401:mortality; D010530:Peritoneal Dialysis; D006435:Renal Dialysis / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: graft survival; intra-abdominal infection; peritoneal dialysis; simultaneous pancreas-kidney transplantation; type 1 diabetes; vascular thrombosis