Long-term outcomes of pancreas after kidney transplantation in small centers

Is it justified?

M. R. Laftavi, O. Pankewycz, Angelika C Gruessner, Murray Brian, R. Kohli, L. Feng, M. Said, R. Sharma, S. Patel

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background. Currently, the long-term advantages of having a pancreas transplantation (PT) are debated, particularly in patients receiving pancreas after kidney (PAK) allografts. The United Network for Organ Sharing (UNOS) requires that a transplant center perform a minimum number of PT per year to remain an active PT center. The long-term outcomes and challenges of PAK in small pancreas transplant centers are not well studied. Methods. In this retrospective analysis, we report short- and long-term outcomes in a small center performing 2-9 PT annually. Results. Forty-eight PT (25 simultaneous pancreas and kidney transplantation [SPK], 23 PAK) were performed in our center. Donor and recipient demographics were similar in both groups. All suitable local donors were used for SPK. All organs for PAK transplantation were imported from other UNOS regions. Mean follow-up was 61 ± 46 and 74 ± 46 months for SPK and PAK, respectively. Patient and graft survival rates were similar in SPK and PAK groups and better than the reported national average. Four patients (11%) died (1 due to trauma, 1 brain lymphoma, 1 ruptured aneurysm; and 1 unknown cause). Two patients (4%; 1 SPK, 1 PAK) lost their grafts because of thrombosis on postoperative days 3 and 5 in 2002. No graft thrombosis occurred since 2002. Seven patients (15%) required reoperation (4 for bleeding, 2 anastomotic leaks, 1 small bowel perforation). Two patients (4%) developed post-transplantation lymphoproliferative disease. Five patients (11%) experienced cytomegalovirus antigenemia which responded well to antiviral therapy. Conclusions. Compared with outcomes for diabetic patients on dialysis, current SPK and PAK short- and long-term results are favorable even in a small PT center. Therefore, unless there is a contraindication, PT should be offered to all type 1 diabetic patients with end-stage renal disease at the time of kidney transplantation or afterward.

Original languageEnglish (US)
Pages (from-to)1920-1923
Number of pages4
JournalTransplantation Proceedings
Volume46
Issue number6
DOIs
StatePublished - 2014

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Pancreas Transplantation
Kidney Transplantation
Pancreas
Kidney
Transplants
Thrombosis
Tissue Donors
Anastomotic Leak
Ruptured Aneurysm
Graft Survival
Cytomegalovirus
Reoperation
Chronic Kidney Failure
Antiviral Agents
Allografts
Dialysis
Lymphoma

ASJC Scopus subject areas

  • Surgery
  • Transplantation

Cite this

Long-term outcomes of pancreas after kidney transplantation in small centers : Is it justified? / Laftavi, M. R.; Pankewycz, O.; Gruessner, Angelika C; Brian, Murray; Kohli, R.; Feng, L.; Said, M.; Sharma, R.; Patel, S.

In: Transplantation Proceedings, Vol. 46, No. 6, 2014, p. 1920-1923.

Research output: Contribution to journalArticle

Laftavi, MR, Pankewycz, O, Gruessner, AC, Brian, M, Kohli, R, Feng, L, Said, M, Sharma, R & Patel, S 2014, 'Long-term outcomes of pancreas after kidney transplantation in small centers: Is it justified?', Transplantation Proceedings, vol. 46, no. 6, pp. 1920-1923. https://doi.org/10.1016/j.transproceed.2014.06.044
Laftavi, M. R. ; Pankewycz, O. ; Gruessner, Angelika C ; Brian, Murray ; Kohli, R. ; Feng, L. ; Said, M. ; Sharma, R. ; Patel, S. / Long-term outcomes of pancreas after kidney transplantation in small centers : Is it justified?. In: Transplantation Proceedings. 2014 ; Vol. 46, No. 6. pp. 1920-1923.
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title = "Long-term outcomes of pancreas after kidney transplantation in small centers: Is it justified?",
abstract = "Background. Currently, the long-term advantages of having a pancreas transplantation (PT) are debated, particularly in patients receiving pancreas after kidney (PAK) allografts. The United Network for Organ Sharing (UNOS) requires that a transplant center perform a minimum number of PT per year to remain an active PT center. The long-term outcomes and challenges of PAK in small pancreas transplant centers are not well studied. Methods. In this retrospective analysis, we report short- and long-term outcomes in a small center performing 2-9 PT annually. Results. Forty-eight PT (25 simultaneous pancreas and kidney transplantation [SPK], 23 PAK) were performed in our center. Donor and recipient demographics were similar in both groups. All suitable local donors were used for SPK. All organs for PAK transplantation were imported from other UNOS regions. Mean follow-up was 61 ± 46 and 74 ± 46 months for SPK and PAK, respectively. Patient and graft survival rates were similar in SPK and PAK groups and better than the reported national average. Four patients (11{\%}) died (1 due to trauma, 1 brain lymphoma, 1 ruptured aneurysm; and 1 unknown cause). Two patients (4{\%}; 1 SPK, 1 PAK) lost their grafts because of thrombosis on postoperative days 3 and 5 in 2002. No graft thrombosis occurred since 2002. Seven patients (15{\%}) required reoperation (4 for bleeding, 2 anastomotic leaks, 1 small bowel perforation). Two patients (4{\%}) developed post-transplantation lymphoproliferative disease. Five patients (11{\%}) experienced cytomegalovirus antigenemia which responded well to antiviral therapy. Conclusions. Compared with outcomes for diabetic patients on dialysis, current SPK and PAK short- and long-term results are favorable even in a small PT center. Therefore, unless there is a contraindication, PT should be offered to all type 1 diabetic patients with end-stage renal disease at the time of kidney transplantation or afterward.",
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T1 - Long-term outcomes of pancreas after kidney transplantation in small centers

T2 - Is it justified?

AU - Laftavi, M. R.

AU - Pankewycz, O.

AU - Gruessner, Angelika C

AU - Brian, Murray

AU - Kohli, R.

AU - Feng, L.

AU - Said, M.

AU - Sharma, R.

AU - Patel, S.

PY - 2014

Y1 - 2014

N2 - Background. Currently, the long-term advantages of having a pancreas transplantation (PT) are debated, particularly in patients receiving pancreas after kidney (PAK) allografts. The United Network for Organ Sharing (UNOS) requires that a transplant center perform a minimum number of PT per year to remain an active PT center. The long-term outcomes and challenges of PAK in small pancreas transplant centers are not well studied. Methods. In this retrospective analysis, we report short- and long-term outcomes in a small center performing 2-9 PT annually. Results. Forty-eight PT (25 simultaneous pancreas and kidney transplantation [SPK], 23 PAK) were performed in our center. Donor and recipient demographics were similar in both groups. All suitable local donors were used for SPK. All organs for PAK transplantation were imported from other UNOS regions. Mean follow-up was 61 ± 46 and 74 ± 46 months for SPK and PAK, respectively. Patient and graft survival rates were similar in SPK and PAK groups and better than the reported national average. Four patients (11%) died (1 due to trauma, 1 brain lymphoma, 1 ruptured aneurysm; and 1 unknown cause). Two patients (4%; 1 SPK, 1 PAK) lost their grafts because of thrombosis on postoperative days 3 and 5 in 2002. No graft thrombosis occurred since 2002. Seven patients (15%) required reoperation (4 for bleeding, 2 anastomotic leaks, 1 small bowel perforation). Two patients (4%) developed post-transplantation lymphoproliferative disease. Five patients (11%) experienced cytomegalovirus antigenemia which responded well to antiviral therapy. Conclusions. Compared with outcomes for diabetic patients on dialysis, current SPK and PAK short- and long-term results are favorable even in a small PT center. Therefore, unless there is a contraindication, PT should be offered to all type 1 diabetic patients with end-stage renal disease at the time of kidney transplantation or afterward.

AB - Background. Currently, the long-term advantages of having a pancreas transplantation (PT) are debated, particularly in patients receiving pancreas after kidney (PAK) allografts. The United Network for Organ Sharing (UNOS) requires that a transplant center perform a minimum number of PT per year to remain an active PT center. The long-term outcomes and challenges of PAK in small pancreas transplant centers are not well studied. Methods. In this retrospective analysis, we report short- and long-term outcomes in a small center performing 2-9 PT annually. Results. Forty-eight PT (25 simultaneous pancreas and kidney transplantation [SPK], 23 PAK) were performed in our center. Donor and recipient demographics were similar in both groups. All suitable local donors were used for SPK. All organs for PAK transplantation were imported from other UNOS regions. Mean follow-up was 61 ± 46 and 74 ± 46 months for SPK and PAK, respectively. Patient and graft survival rates were similar in SPK and PAK groups and better than the reported national average. Four patients (11%) died (1 due to trauma, 1 brain lymphoma, 1 ruptured aneurysm; and 1 unknown cause). Two patients (4%; 1 SPK, 1 PAK) lost their grafts because of thrombosis on postoperative days 3 and 5 in 2002. No graft thrombosis occurred since 2002. Seven patients (15%) required reoperation (4 for bleeding, 2 anastomotic leaks, 1 small bowel perforation). Two patients (4%) developed post-transplantation lymphoproliferative disease. Five patients (11%) experienced cytomegalovirus antigenemia which responded well to antiviral therapy. Conclusions. Compared with outcomes for diabetic patients on dialysis, current SPK and PAK short- and long-term results are favorable even in a small PT center. Therefore, unless there is a contraindication, PT should be offered to all type 1 diabetic patients with end-stage renal disease at the time of kidney transplantation or afterward.

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