Simultaneous pancreas-kidney transplantation: which graft warns the most?

• Published in: Langenbeck's archives of surgery Vol. 408; no. 1; p. 196
• Main Authors: Giuliani, Tommaso, Ibáñez, Javier Maupoey, Montalvá-Orón, Eva, Robledo, Andrea Boscà, Chicote, Cristina Martínez, Sanz, Ana Hernando, Ibañez, Cristina Ballester, Mizrahi, David Calatayud, Castelló, Isabel Beneyto, Torres, Juan Francisco Merino, Andújar, Rafael López
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 16-05-2023
• Subjects: Abdominal Surgery; Cardiac Surgery; Diabetes Mellitus, Type 1; General Surgery; Graft Survival; Humans; Kidney Transplantation - adverse effects; Medicine; Medicine & Public Health; Pancreas; Pancreas Transplantation - adverse effects; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Thoracic Surgery; Traumatic Surgery; Vascular Surgery; Pancreas transplantation; Comprehensive Complication index; Average complication burden; Complications; Kidney transplantation
• ISSN: 1435-2451; 1435-2451
• DOI: 10.1007/s00423-023-02876-7

Background
Simultaneous pancreas-kidney transplantation (SPK) is still characterized by high rates of postoperative complications. This study aims to offer an in-depth characterization of early, medium-term, and late complications following SPK to derive insights for postoperative management and follow-up.
Methods
Consecutive SPK transplantations were analysed. Pancreatic graft (P-graft)- and kidney graft (K-graft)-related complications were analysed separately. The global postoperative course was assessed in three timeframes (early, medium-term, and late) using the comprehensive complication index (CCI). Predictors of complications and early graft loss were explored.
Results
Complications occurred in 61.2% of patients, and the 90-day mortality was 3.9%. The overall burden of complications was significantly high during admission (CCI 22.4 ± 21.1) and decreased gradually afterwards. P-graft-related complications burdened the most in the early postoperative course (CCI 11.6 ± 13.8); postoperative ileus and perigraft fluid collection were the most frequent complications, and pseudoaneurysms, haemorrhages, and bowel leaks were the major concerns. K-related complications were milder but represented the largest proportion of the CCI in the late postoperative timeframe (CCI 7.6 ± 13.6). No predictors of P-graft- or K-graft-related complications were found.
Conclusion
Pancreas graft-related complications represent the largest part of the clinical burden in the early postoperative timeframe but are negligible after 3 months. Kidney grafts have a relevant impact in the long term. The multidisciplinary approach to SPK recipients should be driven based on all graft-specific complications and tailored on a time-dependent basis.