Enteric Conversion of Bladder Drained Pancreas as a Time Dependent Predictor of Outcomes in over 900 Recipients

S. Riad,¹ D. Keys,¹ V. Vakil,¹ S. Jackson,² D. Berglund,² A. Matas,³ R. Kandaswamy.³

¹Renal Disease and Hypertension, University of Minnesota, Minneapolis, MN
²Informatics Services for Research and Reporting, Fairview Health Service, Minneapolis, MN
³Transplant Surgery, University of Minnesota, Minneapolis, MN.

Meeting: 2018 American Transplant Congress

Abstract number: A335

Keywords: Pancreas transplantation, Rejection

Session Information

Session Name: Poster Session A: Pancreas and Islet: All Topics

Session Type: Poster Session

Date: Saturday, June 2, 2018

Session Time: 5:30pm-7:30pm

Presentation Time: 5:30pm-7:30pm

Location: Hall 4EF

Background: Bladder drainage in pancreas transplantation technique has declined due to concern over complications such as severe dehydration, acidosis, hemorrhagic cystitis and recurrent urinary infections necessitating enteric conversion. We sought to study the impact of enteric conversion on the pancreas graft.

Methods: We analyzed 919 pancreas transplant recipients with bladder drainage, of which 177 underwent enteric conversion post-transplant. The data is left truncated at the starting of 2003, as this is when follow-up and retrospective data abstraction began. Multivariate Cox proportional hazards model were used to assess the impact of conversion as a time-dependent covariate on acute rejection, death censored graft survival and patient survival.

Results: In the Cox proportional hazards model, conversion was associated with a 2.3 fold increase in the risk of acute rejection- HR 2.30 (95% CI 1.44, 3.67), p 0.0005. Conversion was not associated with graft loss or mortality.

Cox proportional Hazards for:	Acute Rejection	Death Censored Graft Survival	Patient Mortality
	HR 95% CI p-Value	HR 95% CI p-Value	HR 95% CI p-Value
Conversion	*2.30 (1.44,3.67) 0.0005*	*0.98 (0.68,1.41) 0.90*	*0.93 (0.68,1.24) 0.61*
Age at Transplant	0.96 (0.94,0.98) <0.0001	0.95 (0.94,0.97) <0.0001	1.03 (1.01,1.04) 0.0001
Female Gender	1.26 (0.92,1.73) 0.15	1.07 (0.83,1.37) 0.61	1.00 (0.80,1.24) 0.98
Re-transplant	1.00 (0.65,1.55) 0.99	0.90 (0.60,1.35) 0.62	0.87 (0.59,1.29) 0.49
# of HLA mismatches	1.20 (1.05,1.36) 0.007	0.93 (0.85,1.03) 0.17	0.95 (0.88,1.03) 0.21
CNI Free	1.22 (0.85,1.75) 0.28	1.20 (0.88,1.63) 0.26	1.36 (1.07,1.73) 0.01
mTOR Use	0.86 (0.43,1.74) 0.68	1.10 (0.62,1.94) 0.75	0.81 (0.46,1.42) 0.46
MMF use	0.98 (0.69,1.39) 0.91	1.01 (0.76,1.33) 0.98	0.68 (0.53,0.86) 0.002

Conclusion: Enteric conversion as a time dependent variable was associated with increased risk of rejection but not increased risk of graft loss or mortality. The decision to convert should take into account this increased risk.

CITATION INFORMATION: Riad S., Keys D., Vakil V., Jackson S., Berglund D., Matas A., Kandaswamy R. Enteric Conversion of Bladder Drained Pancreas as a Time Dependent Predictor of Outcomes in over 900 Recipients Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Riad S, Keys D, Vakil V, Jackson S, Berglund D, Matas A, Kandaswamy R. Enteric Conversion of Bladder Drained Pancreas as a Time Dependent Predictor of Outcomes in over 900 Recipients [abstract]. https://atcmeetingabstracts.com/abstract/enteric-conversion-of-bladder-drained-pancreas-as-a-time-dependent-predictor-of-outcomes-in-over-900-recipients/. Accessed November 23, 2024.

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