Pretransplant nephrectomy in patients with autosomal dominant polycystic kidney disease

BACKGROUND: Autosomal dominant polycystic kidney disease (ADPKD) is the most common inherited kidney disease and a frequent cause of end-stage renal failure. Transplantation in patients with ADPKD is associated with specific cyst-related problems, especially urinary tract infections (UTI). Although pretransplant nephrectomy has been applied in this group of patients, evidence of the benefits of this strategy is lacking. Therefore, we compared the outcomes and posttransplant complications among patients with or without pretransplant nephrectomy. PATIENTS AND METHODS: ADPKD patients (73) transplanted from cadaveric donors were reviewed retrospectively with regard to posttransplant complications and outcomes. The groups either underwent pretransplant unilateral nephrectomy (n = 30) or were transplanted with native kidneys intact (n = 43). RESULTS: Two patients underwent simultaneous bilateral nephrectomy due to a large size of the polycystic kidneys interfering with the transplant operation. Overall postransplant complications were more frequent in the group without nephrectomy (34% vs 20%); however, the difference was not statistically significant. Most complications were related to cyst infections with 3 deaths (12%) due to lethal septicemia in the group without nephrectomy. No infection-related deaths were noted in the group with pretransplant nephrectomy. CONCLUSIONS: Graft and patient outcomes as well postransplant complications were similar in both groups, independent of previous nephrectomy. It seems that pretransplant unilateral nephrectomy should not be routine and has no advantage over transplantation with both native kidneys intact, although this conclusion is limited by the small number of patients. An Individualized approach should be applied especially when there has been a history of cyst-related infection.     

Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation?

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? The indications and timing of native nephrectomy in patients with autosomal dominant polycystic kidney disease (ADPKD) is controversial, especially for those undergoing renal transplantation. Post‐transplant unilateral native nephrectomy appears to be the preferred intervention compared to pre‐transplant native nephrectomy. There seems to be substantial additive risk to bilateral over unilateral nephrectomy, especially prior to transplantation. Pre‐transplant native nephrectomy should only be carried out when there are clear indications such as massive size preventing allograft placement, severe pain, early satiety, recurrent bleeding and infections, or suspected malignancy.

OBJECTIVE

To analyse indications, timing and outcomes of native nephrectomy in autosomal dominant polycystic kidney disease (ADPKD) patients listed for kidney transplantation.

PATIENTS AND METHODS

A retrospective analysis of all ADPKD patients who had a native nephrectomy prior to or following transplantation between January 2003 and December 2009 at a single centre, including those undergoing the sandwich technique (removal of the most severely affected native kidney prior to transplantation, and the other afterwards), was undertaken.

RESULTS

There were 35 individuals in our cohort (M : F = 16 : 19), with a median age of 51.5 years (range 43–65). Twenty patients were in the pre‐transplant nephrectomy group, 12 in the post‐transplant group, and three underwent the sandwich technique. Indications for nephrectomy varied but were most commonly pain/discomfort, space for transplantation, ongoing haematuria, recurrent infections, and gastrointestinal pressure symptoms (early satiety). Seven individuals in the pre‐transplant group and three in the post‐transplant group required critical care admission after nephrectomy. Transient renal graft dysfunction occurred in two post‐transplant bilateral nephrectomy patients. Two patients in the bilateral nephrectomy pre‐transplant group and one in the bilateral nephrectomy post‐transplant group died in the immediate post‐operative period. No complications were noted in the sandwich technique group.

CONCLUSION

Native nephrectomy in ADPKD is a major undertaking associated with significant morbidity especially in the pre‐transplant group. Post‐transplant unilateral nephrectomy appears to be the safest approach with fewest complications.     

Meta-analysis of Early Versus Late Ureteric Stent Removal After Kidney Transplantation

Background

Ureteral stents have been widely used in kidney transplantation to prevent postoperative ureter-related complications such as ureteral stricture, ureteral obstruction, and ureteral leakage; however, a longer indwelling ureteral stent time corresponds to a greater risk of complications such as urinary tract infections. Currently, transplantation centers have not yet reached an agreement on the time to remove ureteral stents. Several randomized controlled trials (RCTs) have evaluated the optimal removal time for ureteral stents.

Infective Complications Associated With Ureteral Stents in Renal Transplant Recipients

Objective

Stenting of the ureter is commonly performed during renal transplantation to avoid early complications. However, it predisposes to infections that may pose a significant threat to the graft and patient. Our study sought to investigate the incidence of infections associated with stents in renal transplant recipients.

Patients and Methods

A retrospective analysis of 100 consecutive renal transplant recipients performed over 1 year with 6 months follow-up.

Results

The median recipient age was 46 years (range, 19-71 years). Among the study group, 75 patients received an organ from deceased donor and 25 from live donor. In our study, there were 79 patients with a stent (ST) and 18 without a stent (WOST); 3 patients who required nephrectomy were excluded from the study. There were 2 ureteric stenoses that occurred following stent removal: 1 required surgical correction and 1 was treated radiologically. There were no cases of urinary leak. The incidence of urinary tract infection (UTI) was significantly greater among ST compared with WOST subjects (71% vs 39%; P = .02). New episodes of UTI following removal of the stent were more common among patients who had experienced infections while having a stent compared with infection-free stented patients (54% vs 30%; P = .04).

Conclusions

A ureteric stent may help to reduce early postoperative complications (leak and stricture), but increased the likelihood of UTI. Infection while having a ureteric stent was associated with a high recurrence rate of UTI even after stent removal.     

Urologic complications in kidney transplantation: a single-center experience

Introduction

Urologic complications are an important cause of morbidity in kidney transplantation. To prevent this occurrence, several studies have reported the benefit of stenting. The aim of this study was to compare the efficacy of two different types of stents to protect the urinary anastomosis in kidney transplantation.

Methods

We performed a retrospective analysis of 139 kidney transplant recipients who underwent ureteralneocystostomy by the Lich-Gregoire technique between January 1995 and July 2010. On the basis of the type of stent we divided transplant patients into two groups: group A (n = 90), the internal-external Bracci catheter and group B (n = 49), the double-J stent. The urologic complications evaluated in both groups were: urinary tract leakage, obstruction, and infections. We also recorded the duration of the postoperative hospitalization.

Results

The incidences of urinary fistulae and ureteral strictures between the two groups were similar (around 3%). A higher incidence of urinary infections, however, was registered among group A compared with group B (46% vs 10%; P < .05). The postoperative hospitalization period was consequently longer in group A then group B (35 ± 3 vs 24 ± 2 days; P < .05).

Conclusion

In our series of kidney transplantations, the occurrence of urinary fistulae and ureteral strictures was not influenced by the type of stent. The use of a double-J stent, however, appeared to be associated with a significantly decreased incidence of urinary tract infections leading to shorter postoperative hospitalizations.     

Is removal of the stent at the end of 2 weeks helpful to reduce infectious or urologic complications after renal transplantation?

Objective

Ureteral stents are used to reduce urologic complications after renal transplantation. However, they predispose to infection. The optimal time to keep them in the urinary tract has not yet been defined. The aim of this study was to evaluate the effect of early removal at the end of 2 weeks on urinary tract infections and early urologic complications (within 3 months), such as ureteroneocyctostomy leakage as well as ureteral anastomosis stricture or obstruction.

Methods

We retrospectively analyzed the medical records of 48 patients who underwent renal transplantation using a ureteral stent. The patients were divided into two groups according to the time of stent removal: at the end of 2 weeks (group A; n = 10) versus at a later time (group B; n = 38).

Results

The urologic complication rate was 0% in group A and the urinary tract infection rate, 2%. The urologic complication rate was 0% in group B and the urinary tract infection rate, 35%.

Conclusion

Early removal of the stent at the end of 2 weeks after renal transplantation is decreased the rate of urinary tract infections.     

Acute cyst rupture, hemorrhage and septic shock after a shockwave lithotripsy in a patient with autosomal dominant polycystic kidney disease

The incidence of urinary calculi in autosomal dominant polycystic kidney disease (ADPKD) ranges from 10 to 36 %. Shockwave lithotripsy (SWL) for urinary calculi in ADPKD was reported to be a safe and effective treatment option. However, there is a potential risk of cyst rupture and traumatic hemorrhage because of shockwaves. A 39-year-old female with polycystic kidneys and upper ureter stone was treated with SWL and developed life-threatening complications of cyst rupture, traumatic hemorrhage and septic shock. She was initially treated with supportive care in the intensive care unit, but in the end nephrectomy was performed.     

Autosomal-Dominant Polycystic Kidney Disease and Kidney Transplantation: Experience of a Single Center

Background

Autosomal dominant polycystic kidney disease (ADPKD) is a hereditary disease that frequently leads to end-stage renal disease and is a common indication for kidney transplantation. We sought to evaluate the demographic characteristics, graft and patient survival, and some posttransplantation complications among ADPKD recipients.

Methods

This retrospective study included 445 renal transplant recipients, among whom 48 had ADPKD. We excluded patients with pretransplantation diabetes mellitus. We evaluated patient and graft survivals as well as posttransplantation complications.

Results

There was no difference between the 2 groups with respect to demographic or transplant characteristics, except for older age among the ADPKD group (51.2 ± 8.6 years vs 44 ± 13.1 years; P < .001). We also observed no significant difference with regard to immediate graft function, immunological graft, or patient survival. Although not significant, there was a lower incidence of proteinuria and a greater number of acute rejections among ADPKD patients. As for posttransplantation complications, there was no difference regarding the prevalence of hypertension, but there was more erythrocytosis among the ADPKD group. The incidence of posttransplantation diabetes mellitus was significantly greater in ADPKD patients (33.3% vs 17.1%; P = .009), and remained significant after adjusting for confounding variables by multivariate analysis with an adjusted odds ratio of 2.3 (95% confidence interval, 1.008-5.136; P = .048).

Conclusion

Our results suggested that ADPKD patients display a greater incidence of diabetes mellitus posttransplantation; ADPKD emerged as an independent predictor for this complication.     

Insertion of a Double Pigtail Ureteral Stent for the Prevention of Urological Complications in Renal Transplantation: A Prospective Randomized Study

Purpose

Urologists successfully use ureteral stents to protect the ureterovesical anastomosis in nontransplant patients.

Materials and Methods

We determined the value of ureteral stents in transplant patients. The frequency of urological complications (leaks, obstructions and urinary tract infections) was compared in a prospective randomized series of 194 kidney transplantations (97 with and 97 without a double pigtail ureteral stent).

Results

In the stent group 1 patient had a urinary leak and 35 had urinary tract infections (including 2 cases of Corynebacterium cystitis). In the no stent group 6 patients had urinary leaks, 4 had obstructions and 32 had urinary tract infections. The 1-year patient and graft survival rates were similar in both groups, and renal function at 1 year was also similar (229 versus 208 micromole/1. creatinine in the stent and no stent groups, respectively). A small number of stent related complications occurred (2 stent breakages and 1 stent migration). No stones formed in any case.

Conclusions

Ureteral stent insertion significantly decreases the rate of vesicoureteral leakage and obstruction in renal transplantation.     

Upper Tract Urological Laparoendoscopic Single-Site Surgery (LESS)

Background and Objectives:

Our objective is to report intermediate-term outcomes for patients who have undergone upper tract urologic laparoendoscopic single-site surgery (LESS) at a single institution.

Methods:

From January 1, 2008, through November 30, 2012, 107 cases treated with LESS were identified, including pyeloplasty (n = 30), ureterolithotomy (n = 32), nephrectomy (n = 35; simple = 31, partial = 4), and cyst decortication (n = 10). Perioperative data were reviewed, and conversion and complication rates were noted.

Results:

The median follow-up was 21.5 months for pyeloplasty, 20.5 for ureterolithotomy, 28.0 for simple nephrectomy, 14.0 for partial nephrectomy, and 19.0 for cyst decortication. Major complications were encountered in 8 patients, including 3 intraoperative complications (2 bowel injury with serosal tearing and 1 intraoperative bleeding), which were recognized and repaired with LESS or conversion to conventional laparoscopy (CL). During the intermediate postoperative period (30–90 days) major complications occurred in 5 patients: 4 ureteral strictures (Clavien-Dindo grade [CG] IIIb) and 1 urinoma formation (CG IIIa). During the early postoperative period (<30 days), the most common minor complications were flank pain (CG I) in 16 patients and urinary tract infection (CG II) in 11, followed by urinary leakage (CG I) in 8.

Conclusions:

Intermediate-term functional outcomes of this single-center study confirm that upper tract LESS is a challenging procedure that can be safe and effective when performed by an experienced team. Prospective studies with longer follow-up periods are needed to investigate the safety of LESS in the treatment of various upper urinary tract conditions.     

Native nephrectomy in transplant patients with autosomal dominant polycystic kidney disease

INTRODUCTION

This study examined the clinical indications and timing for native nephrectomy (NN), together with the associated pathological findings in transplant patients with autosomal dominant polycystic kidney disease (ADPKD) at our institute over a period of 20 years.

METHODS

A retrospective review was performed of ADPKD patients who had undergone both kidney transplantation and NN. Patients were identified from the kidney transplant database between 1988 and 2008 at Guy''s and St Thomas'' Hospital and the notes reviewed. All NN specimens were re-reviewed and reported according to current guidelines.

RESULTS

There were 157 kidney transplants performed for ADPKD (114 cadaveric and 43 living donor). Of these, 31 required NN (28 bilateral). The timing of NN was pre-transplant in 10 cases, at the time of the transplant in 1 case and post-transplant in 20 cases. The indications for NN were urinary tract infection (n=14, 45%), pain (n=12, 39%), tumour suspicion (n=3, 10%), haematuria (n=1, 3%) and space (n=1, 3%). Mortality in this NN series was 3%, with a 65% surgical morbidity rate. The length of hospital stay post-NN was significantly longer with open compared with laparoscopic techniques (p=0.003). There were two renal cell carcinomas (RCCs) in this series. Both patients presented with macroscopic haematuria (bilateral pT1a papillary RCCs in one case and a pT3b clear cell RCC in the other case). The incidence of RCC in this series of ADPKD transplant patients was 1.3%.

CONCLUSIONS

We have demonstrated that the majority of ADPKD patients do not require NN, with only 20% of our series undergoing this procedure. The timing of NN is variable and dictated by indication. NN was only required to make space for transplantation in one case (combined kidney and pancreas transplant). The main indications for NN were recurrent infection and pain, where NN can provide a successful outcome. Laparoscopic NN can be performed safely in patients with ADPKD. Haematuria in such patients should not be assumed to be of benign origin and requires exclusion of urinary tract malignancy as the incidence of RCC in this population is at least as common as in the general population.     

Long-term outcome of kidney transplantation in patients with a urinary conduit: a case–control study

Purpose

To study the short- and long-term outcomes of kidney transplantation in patients with a bladder augmentation or urinary diversion compared to patients with a kidney transplantation in a normal functional bladder.

Patients and methods

Between January 2000 and March 2011, 13 patients received 16 grafts into a reconstructed urinary tract. We performed a retrospective case–control study and matched each patient to 4 controls for donor and recipient gender and year of transplantation.

Results

Short- and long-term complications of kidney transplantation occurred in 12 patients, varying from urinary tract infections to medical hospitalization with or without surgical or radiological intervention. In 5 patients, a percutaneous nephrostomy (PCN) was placed followed by surgical re-intervention. In three patients, the grafts failed as a result of chronic rejection and were re-transplanted. There was no graft loss as a result of surgical complications or the reconstructed urinary tract. One-year patient and graft survival was 100 %. After five years, all patients were alive and seven of nine grafts (77.8 %) were functioning. Mean follow-up time was 4.3 years. Among the controls, 55 grafts were transplanted in 52 patients. Ten patients received a PCN. Five patients needed surgical re-intervention. In three patients, transplantectomy was performed for ongoing rejection. Three patients were re-transplanted. One patient had a failing graft 7.5 years post-transplantation and became dialysis dependent.

Conclusion

Kidney transplantation in patients with a reconstructed urinary tract has an increased complication rate. Nevertheless, the long-term results are comparable to patients with a normal urinary bladder.     

DO URINARY TRACT INFECTIONS TRIGGER CHRONIC KIDNEY TRANSPLANT REJECTION IN MAN?

Purpose

Urinary tract infections are frequent after kidney transplantation but little is known about the impact on long-term survival. As chronic rejection is the major cause of graft loss in the long term, we retrospectively analyzed the role of urinary tract infections in this process.

Materials and Methods

We included in the study all adult patients who received kidney transplants at our unit between 1972 and 1991, which ensured followup of at least 5 years, and we focused on the relationship between urinary tract infections and the incidence of chronic rejection episodes. To analyze the influence of urinary tract infections on chronic rejection patients were separated into those in whom biopsy proved chronic rejection developed within the first 5 years after transplantation (chronic rejection group 225) and those without apparent signs of chronic rejection during that period (control group 351). The correlation between urinary tract infections per year and the incidence of chronic rejection was analyzed.

Results

Patients with chronic rejection had more urinary tract infections per year than controls. In the first year after transplantation both groups had the highest incidence of urinary tract infections but thereafter the rate of urinary tract infections per year declined. However, the incidence consistently remained higher in the chronic rejection group. This difference reached significance by year 3 after transplantation. Furthermore, a high rate of urinary tract infections correlated with an early onset of chronic rejection.

Conclusions

Urinary tract infections are an important risk factor for the onset of chronic rejection, and early and intense treatment is critical.     

Living Donor Renal Transplantation Using Grafts With Multiple Arteries Procured by Laparoscopic Nephrectomy

Objective

Kidney grafts with multiple renal arteries (MRAs) are not uncommon, but they do make transplantation more difficult. Laparoscopic graft nephrectomy has become the standard; however, the safety and reliability must be maintained for both a donor and a recipient even in case of MRAs. This study evaluated the short-term outcomes of living donor renal transplant using grafts with MRAs procured by laparoscopic nephrectomy.

Patients and Methods

This study reviewed all living donor kidney transplantations performed from January 2008 to June 2009, which were divided into 3 groups according to the number of renal graft arteries. The serum creatinine level, warm ischemic time (WIT), rewarming time, total ischemic time (TIT), operative time, acute rejection episodes, and complications in each group were evaluated.

Results

The serum creatinine level showed no difference among the groups. Longer TIT was observed in the MRAs group, but WIT and rewarming time did not differ. The acute rejection rate was not different. There were no vessel complications in any donors and recipients.

Conclusion

Harvesting kidney grafts with MRAs by laparoscopic nephrectomy requires a longer TIT; however, transplantation can be performed safely and reliably for both donors and recipients.     

End-To-Side Versus End-to-End Uretero-Ureteral Anastomosis in Kidney Transplant Recipients With Disused Atrophic Bladder

Background

Extravesical Lich-Gregoir ureteroneocystostomy (UC) is the most widely used method for urinary reconstruction during kidney transplantation. Sometimes it is difficult to perform UC in cases with disused atrophic bladder. Pyelo-ureteral anastomosis (PUA) and uretero-ureteral anastomosis (UUA) may be preferred to UC for these patients.

Native Nephrectomy in Renal Transplant Recipients With Autosomal Dominant Polycystic Kidney Disease

Introduction

Patients with autosomal dominant polycystic kidney disease (ADPKD) represent about 10% of kidney transplant recipients (KTR) and have unique needs regarding acceptance for this procedure. Whether native kidney nephrectomy (NKN) affects kidney transplantation (KT) outcomes remains a matter of debate, and more data is needed to establish a standard approach to KTR with ADPKD.

Preoperative Risk Factors Associated With Urinary Complications After Kidney Transplantation

Background

Only surgically irrelevant risk factors including sex, African-American ancestry, or exceptional U-stitch anastomosis have been identified to associate with urinary complications after kidney transplantation. The objective was to identify modifiable and nonmodifiable risk factors associated with urinary complications after kidney transplantation.

Malformative uropathies and kidney transplantation

Introduction

Malformative uropathies are a frequent cause of end-stage renal disease (ESRD) requiring renal replacement therapy (RRT). Medical management of urinary tract infections and advances in surgical reconstruction procedures resulted in good outcomes of kidney transplantation among these patients. The aim of this article was to describe the epidemiological profiles and outcomes of patients who underwent transplantation for ESRD related to malformative uropathies.

Patients and Methods

Among 493 kidney recipients at our center from 1986 to 2009, 47 had malformative uropathies as the cause of ESRD. We retrospectively studied the incidence of acute rejection episodes, acute tubular necrosis, as well as patient and graft survivals, comparing these results to those observed in patients without malformative uropathies using chi-square tests for qualitative parameters and nonpaired Student t tests for continuous variables. Log-rank tests were used for comparisons of survival curves.

Results

The 47 patients, representing 9.53% of our kidney transplant recipients, included 27 men and 20 women (sex ratio = 1.35) with an overall mean age of 27.6 ± 9.1 years (range, 10-49). The common etiology was vesico-ureteral reflux (78.7%). Hemodialysis was the main RRT modality (68%) with a median duration of 41 months. Also, 82.9% of patients received transplants from living donors. Acute tubular necrosis occurred in 4 of these (8.5%) versus 22.06% of the other patients (P = .03). Acute rejection episodes were observed in 13 of these patients (27.6%) versus 23.1% of the other patients (P = not significant [NS]). After a cumulative follow-up period of 3744 months (median, 41.8 months), 5 patients had died (1.6 death/y/100 patients) and 5 had lost their allografts and returned to dialysis (1.6 case/y/100 patients). Graft survival rates at 1, 5, and 10 years were 97.8%, 93.2%, and 79.9%, which were comparable with 95.9%, 87.6%, and 78.9% among the other patients, respectively (P = NS). Patient survival rates at 1, 5, and 10 years were 100%, 88.5%, and 82.6% versus 96%, 87.6%, and 79.6%, respectively (P = NS).

Conclusion

Kidney transplantation in patients with malformative uropathies is increasingly frequent. The incidence of acute rejection episodes as well as patient and graft survivals were comparable with those of subjects without malformative uropathies.     

肾移植治疗常染色体显性遗传性多囊肾病患者的临床效果分析（附43例报告）

目的探讨肾移植治疗常染色体显性遗传性多囊肾病（多囊肾）患者的疗效。方法多囊肾患者43例（多囊肾组）,在不切除原双侧肾脏的前提下,进行肾移植,以同期50例原发病为非多囊肾的肾移植患者作为对照组,进行随访研究。比较两组的术后1、3、5年人、肾存活率及排斥反应发生情况,通过肾脏B超检查多囊肾组患者术前与术后移植肾的体积变化,记录多囊肾组的并发症发生情况。结果多囊肾组肾移植术后1、3、5年人存活率分别为95.3%、90.6%、90.6%,术后1、3、5年肾存活率分别为95.3%、88.3%、83.7%。对照组相应为96.0%、92.0%、90.0%,94.0%、92.0%、88.0%,两组比较差异无统计学意义（P〉0.05）。两组的急性排斥反应发生率比较差异亦无统计学意义（P〉0.05）。多囊肾组术后3～6个月原肾明显缩小,1年后体积基本稳定,跟踪观察1～15年肾脏体积变化不明显。移植后血尿逐渐减轻,7～10d后消失。12例在移植后5～10周反复出现肉眼血尿,均经抗感染治疗后消失。多囊肾患者移植后仍需要应用药物控制血压。多囊肾组尿路感染发生率高达40%。32例多囊肾合并多囊肝,术后发生肝功能损害7例。结论多囊肾患者采用不切除原肾的肾移植效果满意,移植后应严密观察患者移植物肾功能、血尿和感染情况,及时对症处理。     

Influence of simultaneous pancreas and preemptive kidney transplantation on severity of postoperative complications

Background

Simultaneous pancreas and preemptive kidney transplantation (SPpreKT) seems to be the optimal treatment for the patients with diabetes type 1 who are progressing to end-stage renal disease. On the other hand, surgical complications with a high rate of relaparatomy are a limiting factor in pancreas transplantation.

Objective

Comparison of severity of surgical complications was performed between a group of preemptive (SPpreKT group) and nonpreemptive recipients of SPKT (SPKT group).

Methods

Between 1988 and 2010, we performed 112 SPKTs including 25 preemptive recipients (22.3%). The SPKT Group included 87 recipients (77.7%). The severity of complications was classified according to a modified Clavien scale: grade I, no complication; grade II, drug therapy; grade IIIA, invasive intervention not requiring general anesthesia; grade IIIB, invasive intervention requiring general anesthesia; grade IVA, graft failure; and grade IVB, death.

Results

Among the SPpreKT group, 64% of recipients were free from postoperative complications compared with 40.3% of the SPKT group (P < .01). Among the SPKT group, 52 recipients (59.7%) developed 58 postoperative complications, including 15 (17.3%) deaths due to graft pancreatitis (80%) or pancreatic fistula (20%). Among the SPpreKT group, 9 recipients developed 9 complications. None of the preemptively transplanted group subjects experienced a lethal complication. Among the SPpreKT group, the most severe complication was graft pancreatitis leading to graft removal in 2 recipients.

Conclusions

Recipients of preemptive SPKT developed significantly fewer postoperative complications, especially deaths. However the rates of mild (II, IIIA) and moderate (IIIB) complications as well as graft failures (IVA) were similar to the nonpreemptive group.