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Objective To investigate the distribution and drug resistance characteristics of pathogens in donors and recipients undergoing simultaneous pancreas-kidney transplantation (SPK). Methods Clinical data of 231 pairs of donors and recipients undergoing SPK were analyzed retrospectively. The pathogens of samples from donors and recipients were identified by VITEK-2 analyzer, and drug sensitivity test was performed by K-B method. The source distribution and composition ratio of pathogens in donor and recipient samples, distribution characteristics of multi-drug resistant organism, infection of recipients and drug resistance characteristics of pathogens were analyzed. Results A total of 395 strains of pathogens were cultured from 1 294 donor samples, and the detection rate was 30.53%. Gram-negative bacteria mainly consisted of klebsiella pneumoniae, Gram-positive bacteria mainly comprised staphylococcus aureus, and fungi primarily included candida albicans, respectively. In total, 2 690 strains of pathogens were cultured from 10 507 recipient samples, and the detection rate was 25.60%. Gram-negative bacteria mainly consisted of pseudomonas maltophilia, Gram-positive bacteria primarily comprised enterococcus faecalis, and fungi mainly included candida albicans, respectively. Among 395 pathogens of donors, 15 strains of methicillin-resistant staphylococcus aureus (MRSA), 16 strains of extended-spectrum β-lactamase (ESBL) positive drug-resistant bacteria, 8 strains of carbapenem-resistant pseudomonas aeruginosa (CR-PA), 21 strains of carbapenem-resistant acinetobacter baumannii (CR-AB), 2 strains of carbapenem-resistant enterobacteriaceae (CRE) and 1 strain of multiple-drug/pan-drug resistant pseudomonas aeruginosa (MDR/PDR-PA) were identified. Among 2 690 strains of recipient pathogens, 73 strains of ESBL positive drug-resistant bacteria, 44 strains of CR-PA, 31 strains of CR-AB and 3 strains of MDR/PDR-PA were detected. One recipient developed donor-derived infection, 69 cases of pneumonia, 52 cases of urinary tract infection, 35 cases of abdominal infection and 2 cases of hematogenous infection were reported within postoperative 1 year. Gram-negative bacteria were resistant to certain antibiotics. Gram-positive bacteria were sensitive to vancomycin. Fungi were sensitive to amphotericin B. Conclusions Gram-negative bacteria are the main pathogens of SPK recipients, which are resistant to certain antibiotics. Empirical use of antibiotics can be delivered before culture results are obtained. Subsequently, sensitive antibiotics should be chosen according to the culture results to improve the survival rate of SPK recipients.
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Abstract Introduction: Type 1 diabetes mellitus is associated with an increased risk of coronary artery disease, which is frequently asymptomatic. This risk increases significantly in those with nephropathy. In selected patients, simultaneous pancreas-kidney transplantation is the renal and pancreatic replacement therapy of choice, as it increases longevity and stabilizes diabetic complications. Despite essential, universal screening protocols are still controversial for coronary artery disease in this population. Methods: We retrospectively analysed 99 simultaneous pancreas-kidney recipients from our centre from 2011 to 2018 and selected 77 patients who underwent coronary angiography during the pre-transplant evaluation. Our aim was to identify potential risk factors associated with significant lesions on coronary angiography. Results: Almost half of our cohort of 77 candidates submitted to coronary angiography had coronary artery disease. Of these, nearly 30% underwent revascularization, although only one of them reported symptoms of myocardial ischemia. In a univariate analysis, the presence of smoking habits was the only risk factor for coronary artery disease. We also found that 20 or more years of type 1 diabetes mellitus was significantly associated with the presence of coronaropathy. Discussion: Selection of diabetic candidates with acceptable cardiac risk before simultaneous pancreas-kidney transplantation is imperative. Given the impact of a correct diagnosis and a low procedural risk, we defend the routine use of coronary angiography as the initial screening method for coronary artery disease in this population. Particularly care must be taken in evaluating asymptomatic patients with long-term type 1 diabetes mellitus and smokers.
Resumo Introdução: O diabetes mellitus tipo 1 está associado ao risco aumentado de doença arterial coronariana, que é frequentemente assintomática. Este risco aumenta significativamente em pessoas com nefropatia. Em pacientes selecionados, o transplante de pâncreas- rim simultâneo é a terapia substitutiva, renal e pancreática, de escolha, pois aumenta a longevidade e estabiliza complicações diabéticas. Apesar de essenciais, protocolos de triagem universais ainda são controversos para doença arterial coronariana nesta população. Métodos: Analisamos retrospectivamente 99 receptores de pâncreas-rim simultâneo de nosso centro, de 2011 a 2018, e selecionamos 77 pacientes que realizaram angiografia coronária durante avaliação pré-transplante. Nosso objetivo foi identificar fatores de risco potenciais associados a lesões significativas na angiografia coronária. Resultados: Quase metade de nossa coorte de 77 candidatos submetidos à angiografia coronária apresentou doença arterial coronariana. Destes, quase 30% foram submetidos à revascularização, embora apenas um tenha relatado sintomas de isquemia miocárdica. Em uma análise univariada, a presença do hábito de fumar foi o único fator de risco para doença arterial coronariana. Também descobrimos que 20 ou mais anos de diabetes mellitus tipo 1 estavam significativamente associados à presença de coronariopatia. Discussão: A seleção de candidatos diabéticos com risco cardíaco aceitável antes do transplante de pâncreas-rim simultâneo é imperativa. Dado o impacto de um diagnóstico correto e baixo risco de procedimento, defendemos o uso rotineiro da angiografia coronária como método de triagem inicial para doença arterial coronariana nesta população. Deve-se ter um cuidado especial na avaliação de pacientes assintomáticos com diabetes mellitus tipo 1 de longa duração e fumantes.
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Pancreas transplantation and pancreas-kidney transplantation are the optimal treatment for renal failure caused by type 1 diabetes mellitus, partial type 2 diabetes mellitus and their complications. Pancreas transplantation mainly includes simultaneous pancreas-kidney transplantation (SPK), pancreas transplantation after kidney transplantation (PAK) and pancreas transplantation alone (PTA). Among all types of pancreas transplantation, biopsy of pancreas allograft remains the best method for definitively diagnosing rejection and differentiate it from other complications. In this article, biopsy methods of pancreas allograft and related research progress, diagnostic criteria and research progress on rejection of pancreas allograft biopsy, and main complications and pathological manifestations of pancreas allograft were illustrated, aiming to provide reference for guiding the clinical diagnosis of the above mentioned complications and ensuring the long-term survival of pancreas allografts and recipients.
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Objective:To explore the clinical features, etiologies and outcomes of unknown origin fever after simultaneous pancreas-kidney transplantation(SPK).Methods:From March 2015 to January 2020, clinical data were retrospectively reviewed for 120 SPK recipients.According to the definite evidence of fever, such as microbial culture, imaging findings or rejection, they were divided into three groups of free-fever(FF, n=41)and defined-fever(DF, n=47)and fever of unknown origin(FUO, n=32). The differences in general clinical features, surgical complications, laboratory tests and prognoses were compared.Logistic regression was employed for analyzing the risk factors of FUO and Kapla-Meier for survival analysis.And P<0.05 was deemed as statistically significant. Results:Multivariate analysis revealed that preoperative diabetic gastroenteropathy was an independent risk factor for unexplained fever.Significant differences existed between FUO and DF groups in leucocyte count[6.50(5.13, 7.36)vs.10.36(6.11, 12.97)×10 9/L], C-reactive protein(CRP)[11.75(6.25, 16.85)vs.35.00(16.30, 75.00)μg/ml], procalcitonin[0.13(0.06, 0.18)vs.0.19(0.11, 1.05)ng/ml]( P<0.001, P<0.001, P=0.025). As compared with DF group, 19 recipients in FUO group only received 1-2 antibiotics and there was a shorter course of treatment[13(40.6%)vs.32(68.1%), P=0.016]. For 6(18.7%)recipients after a diagnosis of FUO, clinical outcome was achieved with only NSAIDs.Length of stay was(48.72±19.51)days in FUO group versus(57.36±27.46)days in DF group and the difference was statistically significant( P<0.001). Hospitalization expenses of two groups were 253 463.25 and 334 605.96 yuan respectively and the difference was also statistically significant( P=0.002). Conclusions:Diabetic gastroenteropathy is an independent risk factor for early FUO after SPK transplantation.Inflammatory markers of leukocytes, CRP and procalcitonin in FUO patients are significantly lower than DF group.And these clinical features can help diagnose FUO in an early stage.
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Objective:To explore the risk factors of paralytic ileus (PI) after simultaneous pancreas-kidney (SPK) transplantation.Methods:From January 2017 to December 2019, clinical data were reviewed retrospectively for 115 cases of SPK transplantation. The risk factors of PI after SPK were analyzed. According to the occurrence of PI, they were divided into two groups of occurrence and non-occurrence. One-way analysis of variance was utilized for analyzing such influencing factors as gender, age, body mass index (BMI), diabetic type, duration of diabetes, mode of dialysis, duration of dialysis, diabetic gastroenterology, history of open surgery, bowel preparation, operative duration, hemorrhagic volume, immunosuppressant and hypoproteinemia. Multivariate Logistic regression analysis was performed for screening the suspected risk factors.Results:Among them, 19 patients (16.5%) had PI. Univariate analysis showed that PI was associated with diabetic gastroenterology, operative duration, history of open surgery, no bowel preparation and hypoproteinemia ( P<0.05). Multivariate Logistic regression analysis revealed that the risk factors of PI after SPK included diabetic gastroenterology, operative duration time, history of open surgery and no bowel preparation ( P<0.05). Conclusions:Diabetic gastroenterology, operative duration, history of open surgery and no bowel preparation are risk factors for PI after SPK. Clinical interventions for the above factors are necessary.
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BACKGROUND: Simultaneous pancreas-kidney transplantation is the main method for the treatment of end-stage diabetic nephropathy. The quality of donor pancreas is directly related to the surgical safety and long-term survival of the recipient. However, there is yet no unified standard for the evaluation of pancreatic-kidney transplantation in China. OBJECTIVE: To summarize the assessment criteria of donor pancreas transplants base on 63 cases of donation after brain death. METHODS: From September 2016 to November 2018, clinical data of potential pancreas donors after brain death, donor acquisition, and simultaneous pancreas-kidney transplantation were evaluated in the Second Affiliated Hospital of Guangzhou Medical University in China. Pancreas and kidney transplants were from organ donation launched by organ procurement organizations, and the diagnoses of brain death were based on the Criteria for Determination of Brain Death in Adults. We rigorously evaluated and screened potential donors based on the pancreas donor criteria for simultaneous pancreas-kidney transplantation.
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In order to further standardize the clinical techniques for combined pancreas-kidney transplantation, organ transplant specialists under the arrangement of Branch of Organ Transplantation of Chinese Medical Association have formulated this criterion from the aspects of diabetic kidney disease typing diagnosis, indications and contraindications of combined pancreas-kidney transplantation, surgery and surgical complications, immunosuppression programs, rejection, pathology, postoperative recurrent diabetes, follow-up of recipients, etc.
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Objective To explore the surgical indications for pancreas-kidney surgery and summarize the experiences of ,selecting surgical approaches ,formulating immunosuppressive regimens and preventing complications .Methods A total of 145 donor simultaneous pancreas-kidney transplants in uremic patients with T1DM/T2DM between 2002 and 2018 were retrospectively analyzed .Based upon surgical approaches and immunosuppressive agents ,they were divided into three eras of 2002-2010 ,2011-2014 and 2015-2018 respectively .Patient profiles ,survival outcomes of patient and graft , surgical techniques ,immunosuppressive agents and incidence of common complications were compared among different groups .Results The overall 1/3/5-year patient and graft survival rates of three groups were above 75％ and the survival rates of group Ⅰ were inferior to those of groups Ⅱ and Ⅲ(P<0 .001) .The overall 1/3/5-year pancreas graft survival rates were the highest in group Ⅲ and the lowest in group Ⅱ (P=0 .004) .In the 2015-2018 group ,ipsilateral pancreas-kidney transplantation and SE-ED surgery were more preferred .Regarding the incidence of complications ,graft thrombosis frequently occurred from 2011 to 2014 and intestinal obstruction was more common from 2002 to 2010 .For univariable analysis of graft loss ,anticoagulation programme with argatroban monohydrate were 0 .28 times likely to lose pancreas graft (OR= 0 .28 ,95％ CI:0 .09-0 .86) and T1DM patients were 4 times likely to have kidney graft loss (OR=4 .08 ,95％ CI:1 .37-12 .15) .Conclusions SPK is an effective treatment for uremic diabetics . Effective perioperative management and preventing complications are crucial for prolonging patient and graft survivals .
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Objective To explore the indications of simultaneous pancreas-kidney (SPK) transplantation for type 2 diabetes mellitus (DM) combined with end-stage renal disease by comparing the outcome of patients with type 1 and type 2 DM combined with end-stage renal disease after renal transplantation.Methods 109 patients accepting SPK from January 2008 to July 2016 in our center were divided into two groups according to the types of DM:T1DM (n =36),and T2DM (n =73).The basic characteristics of recipients,outcome,and pancreas and kidney functions after operation were compared between two groups.Results There was no significant difference in 5-year survival rate and surgical complications between two groups although recipients of T2DM group were older and had higher BMI than T1DM group.But rejection rate was higher in T1DM group.Conclusion SPK for T2DM recipients will not increase the surgical risk and can get good long-term outcome.
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BACKGROUND: In this era of donor shortage, use of organs from living donors has increased significantly. Nonetheless, less than 1% of pancreas transplantations involve living donors, despite the immunological benefits, reduced cold ischemic time, and decreased waiting time. One reason for the paucity of donors is the high morbidity after open surgery. Using hand-assisted laparoscopic donor surgery (HALDS) can be a favorable technique for living donors. METHODS: Using HALDS, we performed three Simultaneous pancreas-kidney transplantations (SPKs) involving living donors. Two donors were women; one was a man. RESULTS: Their mean age was 34.3±4.7 years, and their body mass index was 23.2±2.36 kg/m². The mean operation time was 241±19.0 minutes and the mean cold-ischemic time of the kidney was 42.7±9.8 minutes, while that of the pancreas was 64.3±5.2 minutes. One donor developed a pancreatic fistula, which was controlled using conservative management. The donors' pancreatic and renal functions were well preserved postoperatively. CONCLUSIONS: HALDS for SPKs can be performed without significant complications if the surgeon has sufficient skill.
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Female , Humans , Body Mass Index , Cold Ischemia , Hand-Assisted Laparoscopy , Kidney Transplantation , Kidney , Living Donors , Pancreas Transplantation , Pancreas , Pancreatic Fistula , Tissue DonorsABSTRACT
Objective To analyze the complications, treatments and prognosis of simultaneous pancreas-kidney transplantation. Methods Forty cases of simultaneous pancreas-kidney transplantation performed between Dec. 1999 and Jan. 2010 in our center were retrospectively analyzed. Results Regarding surgical complications, 4 cases had severe hematuria after operation,which needed clinical intervention, including 1 patient receiving catheterization in duodenum to stop bleeding. Two patients were treated with continuous bladder irrigation, and the remaining one received surgical haemostasis because of donor's duodenum and bladder anastomotic artery hemorrhage.Abdominal hemorrhage occurred in 4 patients, including pancreatic hemorrhage in 3 cases and duodenal muscularis hemorrhage in one case. All of them received surgical treatment for hemostasis.Abdominal infection occurred in 8 cases: one died of multiple organ failure, 2 cases were cured after drainage of abscess, 2 cases underwent surgical removal of abscess, and 3 cases were cured after antibiotic therapy. In one case of postoperative anastomotic leakage, pancreas was resected. Four cases of postoperative ileus were cured by continuous clysis with traditional Chinese medicine. Seven cases had pulmonary bacterial infections, including one cases associated with fungal infection. They were cured by the anti-infective treatment. Other complication included poor healing in 5 cases and urinary infection in 2 cases. After combined simultaneous pancreas-kidney transplantation, 10 patients received reoperation because of surgical complications (14 operations). The re-operation rate was 25 %, including 2 patients (4 operations) for hematuria, 4 patients for abdominal hemorrhage, 2 patients (3 operations) for abdominal infection, 1 patient for pancreatic venous thrombosis, 1 patient for anastomotic leakage, and 1 patient for pancreatic fistula. Conclusion Although simultaneous pancreas-kidney transplantation provides a successful and effective treatment for diabetics with endstage renal disease, surgical complication is still affecting the pancreas and kidney grafts after transplantation.
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En este artículo se describe el estado actual del trasplante de páncreas, los tipos de trasplante más frecuentes -trasplante de páncreas aislado, trasplante de páncreas riñón- sus indicaciones, resultados y las características de receptores y donantes.
This article describes pancreas transplantation, the more frequent modalities such as pancreas transplantation alone and simultaneous pancreas kidney transplantation, their indications and outcomes, as well as the characteristics of suitable recipients and donors.
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Humans , Adult , Donor Selection , Tissue Donors , Transplant Recipients , Pancreas Transplantation/methods , Diabetes Mellitus, Type 1/surgery , Patient Selection , Kidney Transplantation/methodsABSTRACT
O transplante de pâncreas-rim (TSPR) é um dos tratamentos mais efetivos para o paciente com diabetes melito e insuficiência renal crônica. Métodos: Foram realizadas análises retrospectivas da sobrevida de 150 pacientes submetidos ao TSPR pela regressão de COX e determinação das curvas de Kaplan-Meier, além das análises uni - e multivariadas para identificação dos fatores de risco tradicionais e aqueles relacionados ao transplante. Resultados: As taxas de sobrevidas em um ano dos pacientes, dos enxertos renais e pancreáticos foram de 82,0%, 80,0% e 76,7%, respectivamente. Função retardada do enxerto renal (FRR) (P = 0,001, RR 5,41), rejeição aguda renal (P = 0,016, RR 3,36) e infecção intra-abdominal (IIA) (P < 0,0001, RR 4,15) foram os principais fatores de risco que influenciaram a sobrevida do paciente em um ano. A sobrevida do paciente em um ano esteve relacionada à ocorrência de FRR (P = 0,013, RC 3,39), à rejeição aguda renal (P = 0,001, RC 4,74) e à IIA (P = 0,003, RC 6,29). A sobrevida do enxerto pancreático em um ano esteve relacionada à IIA (P < 0,0001, RC 12,83), à trombose vascular (P = 0,002, RC 40,55), à rejeição aguda renal (P = 0,027, RC 3,06), ao sódio do doador > 155 mEq/L (P = 0,02, RC 3,27) e ao uso de dopamina > 7,6 µcg/kg/min (P = 0,046, RC 2,85). Discussão: A ocorrência de função retardada do enxerto renal e infecção intraabdominal teve impacto na sobrevida em um ano tanto do paciente quanto dos enxertos renal e pancreático
Simultaneous pancreas-kidney transplantation (SPKT) is one of the treatments for insulin-dependent patients with chronic renal failure. Methods: One-year patient and kidney allograft survival rates of 150 patients submitted to SPKT analyzed by COX regression and Kaplan-Meier. Uni- and multivariate analysis identified the risk factors involved with either allograft or patient survival. Results: One-year patient and kidney allograft survival rates were 82% and 80%, respectively. Delayed graft function from kidney (DGF) (P = 0.001, HR 5.41), acute kidney rejection (P = 0.016, HR 3.36) and intra-abdominal infection (IAI) (P < 0.0001, HR 4.15) were related to the 1-yr patient survival. One-year kidney allograft survival was also related to DGF (P = 0.013, OR 3.39), acute rejection (P = 0.001, OR 4.74) and IAI (P = 0.003, OR 6.29). Main risk factors for DGF: time on dialysis > 27 months (P = 0.046, OR 2.59), kidney cold ischemia time > 14 hours (P = 0.027, OR 2.94), donor age > 25 years (P = 0.03, OR 2.82) and donor serum sodium > 155 mEq/l (P < 0.0001, OR 1.09). Conclusions: Delayed kidney allograft function and IAI had an important impact on either patient or kidney allograft survival rates. Improving deceased donor care may reduce DGF occurrence.
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Humans , Male , Female , Adult , Middle Aged , Survival Analysis , Pancreas Transplantation/statistics & numerical data , Pancreas Transplantation/mortality , Pancreas Transplantation , Kidney Transplantation/statistics & numerical data , Kidney Transplantation/mortality , Kidney TransplantationABSTRACT
ference in survival and graft function between type 1 and type 2 DM recipients was noted. It is concluded that pancreas-kidney transplantation is an effective way for the treatment of type 1 DM and some type 2 DM complicated with uremia.
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Significant surgical complications occur in about half of patients after simultaneous pancreas kidney transplantation (SPK) with bladder drainage. Urologic complications are very common in bladder-drained pancreas transplants. Urinary obstruction occurs in either the early or the late period following transplantation. Predictors of urological complications after transplantation have not been well established. Early obstruction is usually diagnosed by an increment of serum creatinine or through imaging studies, such as ultrasound and antegrade pyelogram. Surgical management is inevitable when conservative managements fails. If the length of the donor ureter is sufficient, it is possible to redo the ureteroneocystostomy. However, if this is not the case or the stricture is at a high level, a native ureterotransplant ureterostomy may be the procedure of choice. SPK was performed on a 36 year old male patient with insulin dependent diabetes mellitus and diabetic nephropathy. The pancreatic exocrine secretion was drained by duodenocystostomy. The patient developed an obstruction in upper ureter on the postoperative 16th day. On the postoperative 32nd day, a native ureterotransplant ureterostomy with a double J stent was performed. The postoperative course was uneventful. The double J stent was removed on postoperative 112nd day by cystoscope. A subsequent follow up showed excellent pancreatic and renal function.
Subject(s)
Adult , Humans , Male , Constriction, Pathologic , Creatinine , Cystoscopes , Diabetes Mellitus , Diabetic Nephropathies , Drainage , Follow-Up Studies , Insulin , Kidney Transplantation , Kidney , Pancreas , Stents , Tissue Donors , Ultrasonography , Ureter , Ureteral Obstruction , Ureterostomy , Urinary BladderABSTRACT
Objective To explore a best operative method in order to improve operative manipulated skill of simultaneous pancreas-kidney transplantation(SPKT),a model of SPKT was established in dogs.Methods 12 dogs of SPKT were performed in animal model.A renoportal end-to-end anastomoses between the renal and the spleen vein.Only two vascular end-to-side anastomoses between the donor portal vein and recipient ilio-vein,and between the donor celiac arteries and recipient abdominal aorta were constructed.Pancrease was placed in the right iliac fossa and kidney in the left.Pancreatic exocretion goes through bladder drainage.Results Combined resection was successfully performed in 6 dogs and the other underwent simultaneous pancreas-kidney transplantation.Satisfactory result was obtained in 5 survival dog for a mean of (1 5?0 8)days,although 1 dog died from hypopiesis.Conclusions The model is practically feasible and might be used in studying the problems involved in SPKT,which is effective for the treatment of end-stage diabetic nephropathy.