The preferred order of revascularization of pancreas and kidney grafts in simultaneous pancreas-kidney transplants has not yet been established. Increased preservation time might have a negative impact on graft function. In particular increased cold ischemia time is associated with a higher risk of technical failure in pancreas grafts. In this study, we investigate the influence of graft implantation order in simultaneous pancreas-kidney transplants on short- and long-term graft survival.
12,700 simultaneous pancreas-kidney transplants from the Scientific Registry of Transplant Recipients were analyzed. Graft implantation order was determined based on the ischemia times of pancreas and kidney transplants, respectively. Pancreas and kidney graft survival were analyzed depending on graft implantation order at 3 months, 6 months and 5 years using Kaplan-Meier plots. Significance was tested with logrank test and cox regression model.
In 8,454 transplants the pancreas was implanted first (pancreas before kidney, PBK) and in 4,246 transplants the kidney was implanted first (kidney before pancreas, KBP). Mean follow up was 6.6 and 6.3 years for PBK and KBP, respectively. Pancreas graft survival at 3 months was significantly higher in the PBK group (90.6 versus 89.3%, p=0.024). Cox regression analysis revealed that graft implantation order as well as time span between pancreas and kidney implantation were significantly associated with pancreas graft survival at 3 months (p=0.011 and p=0.010, respectively). When kidney graft implantation was delayed by ≥2 hours from pancreas implantation, difference in graft survival increased to 2.3% (90.1 versus 87.8% pour PAR et RAP, p=0.009). Pancreas graft survival at 6 months and 5 years as well as kidney graft survival were similar in both groups.
Pancreas graft implantation first in simultaneous pancreas-kidney transplants increases short-term pancreas graft survival. Graft implantation order does not affect long-term pancreas and kidney graft survival.
To cite this abstract in AMA style:Niclauss N, Bédat B, Andres A, Toso C, Morel P, Berney T. Impact of Graft Implantation Order on Short- and Long-Term Graft Survival in Simultaneous Pancreas-Kidney Transplants, The [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/impact-of-graft-implantation-order-on-short-and-long-term-graft-survival-in-simultaneous-pancreas-kidney-transplants-the/. Accessed January 23, 2020.
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