Contribution of donor and recipient characteristics to short- and long-term pancreas graft survival.

BACKGROUND: Many donor and recipient factors are known to affect pancreas graft survival. However, their relative importance in explaining differences in graft survival is unknown. Purpose of this study was to retrospectively evaluate the impact of donor and recipient factors on pancreas graft survival, and compare their contribution in explaining graft survival differences. MATERIAL/METHODS: Patient records of all 170 pancreas transplantations (158 Simultaneous Pancreas-Kidney; 12 Pancreas-after-kidney) in the period 1997-2008 were reviewed retrospectively to assess recipient factors before/during transplantation, and to assess graft survival. Eurotransplant reports were reviewed to assess donor factors. RESULTS: Death-censored 1-year graft survival was 88.4% and 82.3% at 3 years. Several factors significantly influenced graft survival: female recipient gender (Hazard Ratio (HR) 2.81[1.10-7.14]), enteric graft drainage (HR 2.85[1.15-7.05]), and donor-recipient match on BMI (HR 2.46[1.01-6.02]). None of the donor factors significantly affected survival. Similar results were found for 1-year survival, except for enteric graft drainage and donor-recipient BMI matching. In total, donor factors explained 3.6% and recipient factors 10.0% of the variance in graft survival. Donor factors were more important for 1-year survival (3.1%), but still less important than recipient factors which explained 6.4%. CONCLUSIONS: Recipient factors are more important in explaining differences in pancreas graft survival than donor factors.

Urological complications and their impact on survival after kidney transplantation from deceased cardiac death donors.

Urological complications after kidney transplantation may result in significant morbidity and mortality. However, the incidence of such complications after deceased cardiac death (DCD) donor kidney transplantation and their effect on survival is unknown. Purpose of this study was to estimate the incidence of urological complications after DCD kidney transplantation, and to estimate their impact on survival. Patient records of all 76 DCD kidney transplantations in the period 1997-2004 were reviewed for (urological) complications during the initial hospitalization until 30 days after discharge, and graft survival until the last hospital visit. Urological complications occurred in 32 patients (42.1%), with leakage and/or obstruction occurring in seven patients (9.2%). The latter seems to be comparable with the incidence reported in the literature for deceased heart-beating (DHB) transplantations (range 2.5-10%). Overall graft survival was 92% at 1 year and 88% at 3 years, comparable to the rates reported in the literature for kidneys from DHB donors, and was not affected by urological complications (chi(2) = 0.27, P = 0.61). Only a first warm-ischaemia time of 30 min or more reduced graft survival (chi(2) = 4.38, P < 0.05). We conclude that urological complications occur frequently after DCD kidney transplantation, but do not influence graft survival. The only risk factor for reduced graft survival in DCD transplant recipients was the first warm-ischaemia time.

Pancreas-kidney transplantations with primary bladder drainage followed by enteric conversion: graft survival and outcomes.

BACKGROUND: In the Leiden University Medical Centre, a two-step approach is routinely used in simultaneous pancreas-kidney (SPK) transplantations: primary bladder drainage (BD) followed by elective enteric conversion. The rationale for this approach is to prevent the short-term disadvantages of primary enteric drainage (intra-abdominal abscesses, pancreas graft loss) and the long-term urological complications related to bladder drainage. Aim of the present study is to evaluate survival and (urological) complications of this approach compared to enteric drainage (ED). METHODS: Patient records of all 98 SPK transplantations in the period 1997-2004 were reviewed for complications during the initial hospitalization until 30 days after discharge, and to assess urological complications and graft survival until the last hospital visit. Median duration of follow-up was 4.3 years for pancreas graft survival, 4.7 years for kidney graft survival, and 4.8 years for patient survival. RESULTS: Patient survival was significantly better in BD patients than in ED patients (chi2=9.89 P<0.01). Pancreas graft survival was also better in BD patients after adjustment for the longer pancreas warm ischemia time in BD patients (P=0.05). The survival rates in our patient population seem higher than reported by the International Pancreas Transplant Registry, particularly in BD patients. Urological complications occurred in nine BD patients (10.3%), comparable to the rates reported for enteric-drained grafts. CONCLUSIONS: This two-step approach of SPK transplantation results in excellent survival rates, with urological complication rates comparable to those reported for enteric-drained grafts, and may thus be viewed as a safe and effective procedure of SPK transplantation.