Challenges Associated with Pancreas and Kidney Retransplantation—A Retrospective Analysis

Simultaneous pancreas and kidney transplantation (SPK) is an accepted treatment for diabetic patients with renal failure, and is associated with increased survival and quality of life for recipients. There are only a few publications on the outcomes of simultaneous pancreas–kidney retransplantation (Re-SPK) after previous SPK and the loss of function of both grafts. A total of 55 patients with type 1 diabetes mellitus underwent pancreas retransplantation at our center between January 1994 and March 2021. Twenty-four of these patients underwent Re-SPK after a previous SPK. All 24 operations were technically feasible. Patient survival rate after 3 months, 1 year, and 5 years was 79.2%, 75%, and 66.7%, respectively. The causes of death were septic arterial hemorrhage (n = 3), septic multiorgan failure (n = 2), and was unknown in one patient. Pancreas and kidney graft function after 3 months, 1 year, and 5 years were 70.8% and 66.7%, 66.7% and 62.5%, and 45.8% and 54.2%, respectively. Relaparotomy was performed in 13 out of 24 (54.2%) patients. The results of our study show that Re-SPK, after previously performed SPK, is a technical and immunological challenge, associated with a significantly increased mortality and complication rate; therefore, the indication for Re-SPK should be very strict. Careful preoperative diagnosis is indispensable.

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P1021MARKERS OF “METABOLIC MEMORY” AND KIDNEY GRAFT FUNCTION IN PATIENTS WITH TYPE 1 DIABETES MELLITUS AFTER SIMULTANEOUS PANCREAS-KIDNEY TRANSPLANTATION

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfaa142.p1021 ◽

2020 ◽

Vol 35 (Supplement_3) ◽

Author(s):

Irina Larina ◽

Anastasia Severina ◽

Minara Shamhalova ◽

Marina Shestakova ◽

Larisa Nikankina ◽

...

Keyword(s):

Oxidative Stress ◽

Carbohydrate Metabolism ◽

Graft Function ◽

Metabolic Memory ◽

Kidney Graft ◽

Stress Markers ◽

Pancreas Kidney Transplantation ◽

Simultaneous Pancreas Kidney ◽

Simultaneous Pancreas Kidney Transplantation

Abstract Background and Aims To evaluate the relationship between oxidative stress markers and advanced glycation end products receptor (RAGE) with kidney graft function and complications of end-stage renal disease (ESRD) in patients with type 1 diabetes mellitus (T1DM), who reached stable euglycemia after simultaneous pancreas-kidney transplantation (SPKT). Method The study included 27 patients with T1DM duration for 21 [19; 28] years, diabetic nephropathy (DN) duration 7,0 [5,5; 13,5] years and duration of renal replacement therapy (dialysis) for 2 [1; 4] years after successful SPKT. The posttransplantation period at the time of inclusion was 61 [20; 90] months. Assessment included examination of oxidative stress markers (3-nitrothyrosine (3-NT), superoxide dismutase (SOD) and RAGE, analysis of the main kidney transplant dysfunction markers (KIM-1, NGAL, podocin, IL-18) and state of carbohydrate metabolism with monitoring for 1 year. All patients received three-component immunosuppressive therapy. Results SPKT allowed to achieve stable euglycemia (HbA1c 5.5 [5.1; 5.9] %, 5.5 [5.3; 5.7] % and С-peptide 2,9 [2,1; 3,6] ng/ml, 2,6 [2,0; 3,4] ng/ml at baseline and after 1 year of follow – up, respectively) and the restoration of graft function to the rate of estimated glomerular filtration rate (eGFR) CKD-EPI stage C2, albuminuria stage A1 of chronic kidney disease (CKD). However, 22% of patients experienced an increase of albumin-to-creatinine ratio to A2 at different times after surgical treatment. There was a statistically significant increase in SOD level (p=0.0005) and RAGE level (p=0.011) after 12 months of observation. Significant correlations of kidney transplant function parameters with “metabolic memory" markers (oxidative stress and RAGE) were also found: RAGE & creatinine (R=0.50, p=0.02), RAGE & KIM-1 (R=0.43, p=0.047), 3-NT& eGFR (R= - 0.40, p=0.046), IL-18 & SOD baseline (R=0.43, p=0.047). Attention is drawn to the correlations of RAGE & HbA1c+12 month (R=0.47, p=0.01), podocin with HbA1c (R=-0.46, p=0.03), which may probably reflect the direct influence of carbohydrate metabolism compensation to the kidney graft condition and also the correlation of SOD baseline & RAGE +12 month (R= - 0.70, p=0.0008), which may demonstrate the relative influence of components of "metabolic memory”. Conclusion SPKT as the way to achieve compensation of carbohydrate metabolism remains just one of factors of stable kidney graft function. The results of analysis of “metabolic memory” markers could indicate not only their direct contribution to the persistence of metabolic consequences of DM and DN, but also their possible participation in the development of recurrent nephropathy.

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Which Factors Influence Quality of Life of Type 1 Diabetic Patients with End-Stage Renal Disease Subjected to Kidney or Simultaneous Pancreas-Kidney Transplantation?

Transplantation Journal ◽

10.1097/00007890-201211271-01346 ◽

2012 ◽

Vol 94 (10S) ◽

pp. 685

Author(s):

D. Bożek-Pajak ◽

A. Kowalik ◽

J. Ziaja ◽

M. Farnik ◽

A. Kolonko ◽

...

Keyword(s):

End Stage Renal Disease ◽

Diabetic Patients ◽

Pancreas Kidney Transplantation ◽

Simultaneous Pancreas Kidney ◽

Stage Renal Disease ◽

End Stage ◽

Type 1 Diabetic Patients ◽

Simultaneous Pancreas Kidney Transplantation

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Differences in health-related quality of life between type 1 and type 2 diabetic patients in Austria

Endocrine Abstracts ◽

10.1530/endoabs.70.aep1040 ◽

2020 ◽

Author(s):

Nawras Al-taie ◽

Harald Stingl ◽

Delia Maftei

Keyword(s):

Quality Of Life ◽

Diabetic Patients ◽

Health Related Quality ◽

Type 2 Diabetic Patients ◽

Related Quality ◽

Health Related ◽

Type 2 Diabetic

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Periodontal treatment increases quality of life outcomes in Type 1 and Type 2 diabetic patients with periodontitis: the randomized-controlled trial DIAPERIO

10.26226/morressier.5ac383212afeeb00097a4418 ◽

2018 ◽

Author(s):

Thibault Canceill

Keyword(s):

Quality Of Life ◽

Controlled Trial ◽

Diabetic Patients ◽

Life Outcomes ◽

Type 2 Diabetic Patients ◽

Randomized Controlled ◽

Type 2 Diabetic

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Clinico-expert diagnostics of gastrointestinal form of diabetic neuropathy

Diabetes Mellitus ◽

10.14341/2072-0351-5644 ◽

2011 ◽

Vol 14 (2) ◽

pp. 94-97

Author(s):

Irina Alekseevna Kurnikova ◽

Tatiana Evgen'evna Chernyshova ◽

Irina Vladimirovna Gur'eva ◽

Guzyal' Ilgisovna Kliment'eva

Keyword(s):

Gastrointestinal Tract ◽

Diabetic Neuropathy ◽

Diabetic Patients ◽

Parasympathetic Innervation ◽

Gastric Tone ◽

Functional Changes ◽

Gastrointestinal Pathology ◽

Upper Gastrointestinal

Aim. To estimate dynamics of secretory and motor-evacuational functions of the stomach in patients with type 1 diabetes mellitus and gastrointestinalform of diabetic neuropathy. Materials and methods. 32 patients with DM1 without gastrointestinal pathology allocated to different groups depending on DM duration (gr. 1 lessthan 10 yr, gr. 2 over 10 yr). Vegetative equilibrium was estimated from the Kerdo index, rehabilitative potential from its basic constituent (morphophysiologicalindex). The motor-evacuational function of the stomach was studied with the use of a scintillation gamma-chamber, the gastric secretoryfunction by pH measurements. Results. Half of the patients in gr 2 presented with hypersympathicotony. The frequency of hypertonic form of gastric tone increased with durationof DM while the acid-producing and evacuational functions of the stomach decreased (as estimated by pH-measurement and gastroscintiographyrespectively). The propulsive function most significantly decreased in the pyloric part. The efficacy of rehabilitation of diabetic patients with gastrointestinalform of diabetic neuropathy was much lower than in those with preserved vegetative function of the stomach. Conclusion. Impairment of evacuational function of the stomach and duodenum with DM1 duration may be a cause of unstable blood glucose level.Hypomotor dyskinesia of the upper gastrointestinal tract due to DM1 and deficit of parasympathetic innervation occurs more frequently in patientswith low rehabilitative potential. Functional changes in the gastrointestinal tract of DM1 patients do not depend on the quality of compensation ofmetabolic disorders but correlate (r=-0.39) with DM duration. It is concluded that the gastrointestinal form of diabetic neuropathy impairs rehabilitativepotential of fhe patients.

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Pancreas after living donor kidney transplants in diabetic patients: impact on long-term kidney graft function

Clinical Transplantation ◽

10.1111/j.1399-0012.2009.00998.x ◽

2009 ◽

Vol 23 (4) ◽

pp. 437-446 ◽

Cited By ~ 72

Author(s):

Francois Kleinclauss ◽

Martin Fauda ◽

David E.R. Sutherland ◽

Colette Kleinclauss ◽

Rainer W. Gruessner ◽

...

Keyword(s):

Living Donor ◽

Graft Function ◽

Diabetic Patients ◽

Kidney Graft ◽

Kidney Transplants ◽

Donor Kidney ◽

Living Donor Kidney

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Pancreas transplantation: review

Einstein (São Paulo) ◽

10.1590/s1679-45082015rw3163 ◽

2015 ◽

Vol 13 (2) ◽

pp. 305-309 ◽

Cited By ~ 11

Author(s):

Roberto Ferreira Meirelles Júnior ◽

Paolo Salvalaggio ◽

Alvaro Pacheco-Silva

Keyword(s):

Pancreas Transplantation ◽

Glycosylated Hemoglobin ◽

The United States ◽

Diabetes Patient ◽

Pancreas Transplant ◽

First Year ◽

Diabetic Patients ◽

Glucose Levels ◽

Simultaneous Pancreas Kidney

ABSTRACT Vascularized pancreas transplantation is the only treatment that establishes normal glucose levels and normalizes glycosylated hemoglobin levels in type 1 diabetic patients. The first vascularized pancreas transplant was performed by William Kelly and Richard Lillehei, to treat a type 1 diabetes patient, in December 1966. In Brazil, Edison Teixeira performed the first isolated segmental pancreas transplant in 1968. Until the 1980s, pancreas transplants were restricted to a few centers of the United States and Europe. The introduction of tacrolimus and mycophenolate mofetil in 1994, led to a significant outcome improvement and consequently, an increase in pancreas transplants in several countries. According to the International Pancreas Transplant Registry, until December 31st, 2010, more than 35 thousand pancreas transplants had been performed. The one-year survival of patients and pancreatic grafts exceeds 95 and 83%, respectively. The better survival of pancreatic (86%) and renal (93%) grafts in the first year after transplantation is in the simultaneous pancreas-kidney transplant group of patients. Immunological loss in the first year after transplant for simultaneous pancreas-kidney, pancreas after kidney, and pancreas alone are 1.8, 3.7, and 6%, respectively. Pancreas transplant has 10 to 20% surgical complications requiring laparotomy. Besides enhancing quality of life, pancreatic transplant increases survival of uremic diabetic patient as compared to uremic diabetic patients on dialysis or with kidney transplantation alone.

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