Simultaneous pancreas-kidney transplantation in one Russian transplant center
Ilya Dmitriev1, Roman Storozhev1, Aslan Balkarov1, Nikita Zhuravel1, Yuri Anisimov1, Alexandr Kondrashkin1, Denis Lonshakov1, Nonna Shmarina1, Roman Kalashnik1, Svetlana Shchelykalina2, Alexey Pinchuk1,3,4.
1Kidney and Pancreas Transplantation, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow, Russian Federation; 2Medical Cybernetics and Computer Science MBF, Pirogov Russian National Research Medical University, Moscow, Russian Federation; 3Transplantology and Artificial Organs, MSMU n. a. A.I. Evdokimov, Moscow, Russian Federation; 4Research Institute of Healthcare and Medical Management, Moscow, Russian Federation
Introduction: Simultaneous pancreas-kidney transplantation (SPKT) is the best medical option to achieve stable euglycemia and insulin independence in patients with type 1 diabetes mellitus and end-stage renal disease. The outcomes of SPKT in one transplant center with the largest number of pancreas transplantations in Russia are presented.
Methods: The retrospective analysis of 79 SPKT performed at our transplant center from January 2008 to December 2021 was made. Besides, the impact of significant factors that affect the outcomes of SPKT was done. Intra-abdominal pancreas transplantation with duodenoejunoanastomosis was performed in 18 recipients (22.8%). Retroperitoneal pancreas transplantation was performed in 61 patients (77.2%), exocrine drainage was maid via duodenoduodenoanastomosis in 50 patients (63.3%) and via duodenojejunoanastomosis in 11 patients (13.9%). In 69 patients (87.3%) vascular reconstruction with a Y-shaped graft was used, in 9 cases (11.4%) the pancreas graft with isolated splenic artery blood supply was used and the pancreas graft with triple blood supply (gastroduodenal, superior mesenteric and splenic arteries) was used in 1 recipient (1.3%).
Results: Rates of immunological and surgical complications were 25.3% and 43.4%, respectively. The rate of non-vascular complications was significantly higher than the rate of vascular complications (77.5% vs. 22.5%; p<0.001). 1-, 5- and 10-year uncensored and death-censored survival rates were 83.4%, 79.8%, 72.6% and 88.2%, 86.1%, 83.7% for kidney graft and 75.7%, 70.8%, 61.7% and 82.9%, 79.2%, 71.0% for pancreas graft. 1-, 5- and 10-year patient survival rate was 84.6%, 82.9% and 78.0%, respectively. The factors that significantly affected the pancreas graft survival were duration of renal replacement therapy (p=0.001), Clavien IIIb surgical complications (p=0.046), reoperations (p=0.001) and kidney graft failure (p<0.0001). The factors that significantly affected the patient graft survival were duration of renal replacement therapy (p=0.007), diabetes mellitus duration (p=0.006), Clavien IIIb (p=0.016) and IVa (p=0.03) surgical complications, reoperations (p<0.001), kidney and pancreas graft failure (p<0.001).
Conclusion: The results of SPKTx at the N.V. Sklifosovsky Research Institute for Emergency Medicine are comparable to those in most transplant centers.
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