High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation |
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| Authors: | Julia Torabi Jeffrey Melvin Alma Rechnitzer Juan P. Rocca Maria Ajaimy Luz Lirano-Ward Yorg Azzi Cindy Pynadath Omar Alani Enver Akalin Jay A. Graham |
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| Affiliation: | 1. Albert Einstein College of Medicine, Bronx, NY, USA;2. Montefiore-Einstein Center for Transplantation, Montefiore Medical Center, Bronx, NY, USA;1. Senior Advisor (Medicine & Pulmonary Medicine), Military Hospital (Cardio Thoracic Center), Pune-411040, India;2. Associate Professor, Department of Radiology, Armed Forces Medical College, Pune-411040, India;3. Commandant, Military Hospital Mhow, C/o 56 APO, India;1. Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA;2. College of Medicine and Allied Health Sciences, Freetown, Sierra Leone;3. University of Massachusetts Medical School, Worcester, MA, USA;3. Université Pierre et Marie Curie, Université Paris 06, Paris 75005, France;4. INSERM UMR S 938, Laboratory of Cell Signaling and Carcinogenesis, Paris 75012, France;5. Cancer Institute and Department of Biochemistry, University of Mississippi Medical Center, Jackson, Mississippi 39216;1. Department of Surgery, University of South Alabama, Mobile, AL, USA;2. Department of Surgery, University of Alabama-Birmingham, Birmingham, AL, USA;3. Department of Surgery, Loyola University Medical Center, Maywood, IL, USA |
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| Abstract: | BackgroundSimultaneous pancreas and kidney transplantation (SPK) in the setting of end-stage renal disease offers unmatched outcomes in insulin dependent diabetic patients. Donor pool expansion through the transplantation of kidneys with acute kidney injury (AKI) is controversial.Methods59 SPK transplants were classified by presence of donor AKI, defined as donor terminal creatinine ≥ 1.5x the initial creatinine or donor terminal creatinine > 4.0 mg/dL. Endpoints included graft and patient survival, delayed graft function (DGF), serum creatinine, glomerular filtration rate (GFR), Hemoglobin A1c (HbA1c) and acute rejection.ResultsThe donor AKI group (n = 35) had significantly higher rates of DGF (38 v. 9%, p = 0.01). There was no difference in creatinine or GFR at 1, 3, 6 and 12 months. HbA1c was comparable at 3, 6 and 12 months. There was no significant difference in the percentage of patients that required anti-diabetic agents after transplant (14 v. 4%, p = 0.56).ConclusionsWe observed increased rates of DGF in SPK recipients with donor AKI. However, equivalent outcomes of pancreas and kidney function in both groups were observed. |
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| Keywords: | Simultaneous pancreas kidney transplantation Donor acute kidney injury Delayed graft function Graft function |
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