Asynchronous Kidney Allograft Loss After Simultaneous Pancreas-Kidney Transplantation: Impact on Pancreas Allograft Outcome at a Single Center

• Published in: Transplantation proceedings 2009-06, Vol.41 (5), p.1773-1777
• Main Authors: Rangel, E.B, Gonzalez, A.M, Linhares, M.M, Aguiar, W.F, Nogueira, M, Ximenes, S, Sá, J.R, Melaragno, C.S, Medina-Pestana, J.O
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Biological and medical sciences; Brazil; Diabetes Mellitus - surgery; Diabetic Nephropathies - surgery; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Glycated Hemoglobin A - analysis; Humans; Immunosuppressive Agents - therapeutic use; Kidney Transplantation - immunology; Kidney Transplantation - mortality; Kidney Transplantation - pathology; Male; Medical sciences; Middle Aged; Pancreas Transplantation - immunology; Pancreas Transplantation - pathology; Reoperation; Retrospective Studies; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Tissue, organ and graft immunology; Transplantation, Homologous - mortality; Transplantation, Homologous - pathology; Treatment Failure; Treatment Outcome; Young Adult
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2009.01.107

Abstract Objective We analyzed the clinical evolution of pancreas allografts in simultaneous pancreas-kidney transplantation (SPKT) cases after asynchronous kidney allograft loss and kidney retransplantation at a single non-United States center. Patients and Methods We performed a retrospective analysis of 168 SPKT from December 2000 to June 2007. Results The 5-year kidney allograft survival rate was 71%. Excluding cases of death with a functioning graft after SPKT (n = 35; 74.4%), 12 kidney allografts were lost due to acute rejection (n = 7; 15%) or chronic allograft nephropathy (n = 5; 10.6%). Delayed graft function contributed to kidney allograft loss. Five of 12 patients underwent kidney retransplantation. Sixty percent of pancreas allografts were lost after this procedure, which was attributed to either the diabetogenic effects of the immunosuppressive regimen or to the perioperative stress. Oral glucose tolerance tests performed before kidney retransplantation identified patients with good pancreas allograft function versus those with intolerance on glucose tests who received reduced glucocorticoid doses. Conclusions In SPKT, pancreas allograft function was seriously affected by kidney retransplantation. Oral glucose tolerance tests performed before kidney retransplantation were helpful to assess beta-cell function and suggest prescription of lower steroid doses to decrease the pancreas allograft dysfunction.