More Than 25 Years of Pancreas Graft Survival After Simultaneous Pancreas and Kidney Transplantation: Experience From the World's Largest Series of Long-term Survivors
| Autor: | Brenda Muth, Hans W. Sollinger, Neetika Garg, Didier A. Mandelbrot, Sandesh Parajuli, Natalie M. Bath, Fahad Aziz, Arjang Djamali, Robert R. Redfield, Dixon B. Kaufman, Jon S. Odorico |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Time Factors medicine.medical_treatment Comorbidity Article Coronary artery disease Postoperative Complications Diabetes mellitus Humans Medicine Survivors Pancreas Kidney transplantation Transplantation business.industry Proportional hazards model Graft Survival Hazard ratio Middle Aged medicine.disease Kidney Transplantation Surgery Diabetes Mellitus Type 1 Treatment Outcome medicine.anatomical_structure Amputation Kidney Failure Chronic Female Pancreas Transplantation business Follow-Up Studies |
| Zdroj: | Transplantation |
| ISSN: | 0041-1337 |
| Popis: | Background The first simultaneous pancreas and kidney (SPK) transplant was performed in 1966. Early procedures were associated with significant morbidity and mortality and were performed in very low numbers in select patients. Methods This study includes all recipients of an SPK at the University of Wisconsin-Madison between 1986 and 1993, who were actively followed and had a functional pancreas allograft for >25 years as of October 31, 2018. Results A total of 291 SPK were performed during the study period; of these, 39 patients still had a functional graft at last follow up and 9 (18.8%) pancreas grafts were lost due to patient death or graft failure after >25 years. At last follow up, all 39 patients with functional pancreas graft had at least one comorbidity, such as hypertension, hyperlipidemia, or coronary artery disease. Twenty-seven required enteric conversion; 11 patients experienced renal allograft failure (10 underwent a repeat kidney transplant); and 6 required amputation of part of the lower extremity. In the Cox regression analysis, bladder drained pancreas was associated with lower probability of prolonged pancreas graft survival (hazard ratio: 0.52; confidence interval: 0.32-0.85; P = 0.01). Conclusions With careful and detailed follow-up and attention to complications, some recipients of pancreas grafts have outstanding outcomes. As the number of pancreas recipients with prolonged graft survival may be rising, healthcare providers should be aware of the management of complications associated with this unique group of patients. |
| Databáze: | OpenAIRE |
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