Transplant Surgeon
Transplant Center, Department of Surgery
Leiden University Medical Center
Early graft loss in solitary pancreas transplant recipients within Eurotransplant
Jacob de Bakker1, Marko M Mallat2, Milou M Van Bruchem3, Danny D Van der Helm1,2, Marieke M Van Meel3, Aiko A de Vries2, Eelco E de Koning2, Robert R Pol4, Ian I Alwayn1, Andre A Baranski1, Christian C Margreiter5, Volkert V Huurman1.
1Surgery, Leids University Medical Centre, Leiden, Netherlands; 2Nephrology, Leids University Medical Centre, Leiden, Netherlands; 3Eurotransplant, Leiden, Netherlands; 4Surgery, University Medical Centre Groningen, Groningen, Netherlands; 5Surgery, Medical University of Innsbruck, Innsbruck, Austria
Introduction: Previous reports have demonstrated that the risk of allograft failure is higher in solitary pancreas transplantation (PTx) compared to simultaneous pancreas-kidney transplantation (SPK). Specific factors influencing transplant outcome have mainly been studied in SPK recipients. This study aims to investigate the outcomes specifically after PTx and focuses on identifying risk factors for early graft loss in the first 90 days.
Methods: A retrospective cohort analysis was performed on a database of all consecutive solitary pancreas transplantations within the Eurotransplant region from 1 January 2000 until 31 December 2018. In case of missing values, multiple imputation was used to complete the dataset in order to avoid bias, to add power to the analysis and to improve the validity of the study.
Results: Early graft loss (<90 days) occurred in 80 (24.3%) patients. Causes of early graft loss were: thrombosis in 59 (73.8%), bleeding in 5 (6.3%), rejection in 3 (3.8%), infectious problems in 8 (10.1%) and other in 5 (6.3%) transplants respectively. Multivariable analysis revealed that age of the recipient (odds ratio 0.97, P= 0.035), cardiovascular history (odds ratio 1.75, P= 0.046), male gender of donor [VH1] [JdB2] (0.57, P = 0.016), BMI of donor (odds ratio 1.08, P= 0.046) and steroid use after transplant (odds ratio 0.51, P 0.050) were significantly associated with early graft survival. Interestingly, in a subgroup analyses it was shown that PTx of female donors into female recipients have a significantly worse outcome compared to male to male transplants with a graft survival of 62.3% vs 79.2% (p 0.014) in the first 90 days, respectively.
Conclusion: This Eurotransplant Registry analysis is one of the largest on single pancreas transplantation known in the literature. Several donor- and recipient-related factors were identified that showed association with early outcome. These included known factors within the SPK population (e.g. donor age and cardiovascular history). However, some additional factors have to be taken into account. Single pancreas patients should be considered a specific group with higher chance of early failure.
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Lectures by Volkert Huurman
| When | Session | Talk Title | Room |
|---|---|---|---|
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Sat-28 11:35 - 12:35 |
Miscellaneous topics 1 | Early graft loss in solitary pancreas transplant recipients within Eurotransplant | Indigo H |