title: Impact of graft implantation order on graft survival in simultaneous pancreas-kidney transplantation.
abstract: The optimal order of revascularization for pancreas and kidney grafts in simultaneous pancreas-kidney transplantation has not been established. In this study, we investigate the influence of graft implantation order on graft survival in SPK. 12 700 transplantations from the Scientific Registry of Transplant Recipients were analyzed retrospectively. Graft implantation order was determined based on the reported ischemia times of pancreas and kidney grafts. Pancreas and kidney graft survivals were analyzed depending on graft implantation order at 3 months and 5 years using Kaplan-Meier plots. Significance was tested with log-rank test and Cox regression model. In 8454 transplantations, the pancreas was implanted first (PBK), and in 4246 transplantations, the kidney was implanted first (KBP). The proportion of lost pancreas grafts at 3 months was significantly lower in PBK (9.4% vs. 10.8%, P = 0.011). Increasing time lag (>2 h) between kidney and pancreas graft implantation in KBP accentuated the detrimental impact on pancreas graft survival (12.5% graft loss at 3 months, P = 0.001). Technical failure rates were reduced in PBK (5.6 vs. 6.9%, P = 0.005). Graft implantation order had no impact on kidney graft survival. In summary, although observed differences are small, pancreas graft implantation first increases short-term pancreas graft survival and reduces rates of technical failure.
authors.affiliation: Divisions of Visceral and Transplantation Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.
authors.forename: Nadja
authors.initials: N
authors.lastname: Niclauss
authors.affiliation: Divisions of Visceral and Transplantation Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.
authors.forename: Benoît
authors.initials: B
authors.lastname: Bédat
authors.affiliation: Divisions of Visceral and Transplantation Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morel
authors.affiliation: Divisions of Visceral and Transplantation Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.
authors.forename: Axel
authors.initials: A
authors.lastname: Andres
authors.affiliation: Divisions of Visceral and Transplantation Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.
authors.forename: Christian
authors.initials: C
authors.lastname: Toso
authors.affiliation: Divisions of Visceral and Transplantation Surgery, Department of Surgery, University of Geneva Hospitals and School of Medicine, Geneva, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Berney
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000150:complications / Q000601:surgery; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D016035:Pancreas Transplantation / Q000379:methods* / Q000401:mortality; D010182:Pancreatic Diseases / Q000150:complications / Q000601:surgery*; D016016:Proportional Hazards Models; D012044:Regression Analysis; D051437:Renal Insufficiency / Q000150:complications / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Simultaneous pancreas-kidney transplantation; graft implantation order; graft survival; registry study