Session Name: Pancreas and Islet: All Topics
Session Date & Time: None. Available on demand.
*Purpose: Technical complications requiring early relaparotomy (relap) and allograft pancreatectomy (AP) have long been the Achilles heel of simultaneous kidney-pancreas transplantation (SKPT).
*Methods: Single center retrospective review of all SKPTs from 11/1/01 – 8/12/20 managed with T-cell depleting antibody, tacrolimus, MMF, steroids, and enteric exocrine drainage. Anticoagulation other than ASA 81 mg was not routinely used. Early relap was defined as occurring within 3 months of SKPT. Patients (pts) were stratified into 2 sequential eras: Era 1 (E1): 11/1/01 – 5/30/13; Era 2 (E2) 6/1/13 – 8/12/20.
*Results: During the period of study, 255 SKPTs were performed (E1, n=165; E2, n=90) with an overall mean follow-up of 8.1±5 years. Recipient age and donor and recipient ethnicity, gender, and BMI were comparable between eras. E1 pts received organs from older donors (E1 27 vs. E2 23 years, P<0.001) with longer pancreas graft cold ischemic times (CIT) (E1 16 vs. E2 13 hours, P=0.04). E2 pts received more imported organs (E1 16% vs. E2 27%, P=0.04). E1 pts had a higher early relap rate (E1 43% vs. E2 14%, P<0.001) and were more likely to require AP (E1 10.3% vs E2 2.2%, P=0.019). E2 pts underwent systemic venous drainage more frequently (E1 8% vs. E2 29%, P<0.001). The most common indications for early relap in E1 were pancreas thrombosis (12%), abscess/infection (12%), bleeding (4%), and leak (4%) whereas in E2 were for abscess/infection (3%), small bowel obstruction (3%), and thrombosis (2%), P=0.001. Pancreas venous drainage technique did not affect either early relap or AP rates. Actuarial death-censored pancreas graft survival rates are shown in Table 1. Mean transplant volume was 14/year for E1 and 13/year for E2; mean transplant volume in the past 3 years of E2 was 18/year.
*Conclusions: Maximizing donor quality (younger donors) and minimizing CIT are paramount for reducing complications requiring either early relap or AP and for optimizing long-term pancreas graft survival following SKPT. Considering that the pancreas is the only organ for which supply exceeds demand, this can be achieved without compromising transplant volume by judicious use of imported organs.
To cite this abstract in AMA style:Sharda B, Gurung K, Stratta R, Farney A, Orlando G, Jay C, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Doares W, Kaczmorski S, Magid M, Rogers J. Achilles Heel No Longer: Marked Decline in Early Relaparotomy and Allograft Pancreatectomy Rates Following Simultaneous Kidney-Pancreas Transplantation in the Contemporary Era [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/achilles-heel-no-longer-marked-decline-in-early-relaparotomy-and-allograft-pancreatectomy-rates-following-simultaneous-kidney-pancreas-transplantation-in-the-contemporary-era/. Accessed June 18, 2021.
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