High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation
Simultaneous 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. 59 SPK transplants were clas...
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| Veröffentlicht in: | The American journal of surgery 2021-04, Vol.221 (4), p.677-680 |
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| creator | Torabi, Julia Melvin, Jeffrey Rechnitzer, Alma Rocca, Juan P. Ajaimy, Maria Lirano-Ward, Luz Azzi, Yorg Pynadath, Cindy Alani, Omar Akalin, Enver Graham, Jay A. |
| description | Simultaneous 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.
59 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.
The 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).
We observed increased rates of DGF in SPK recipients with donor AKI. However, equivalent outcomes of pancreas and kidney function in both groups were observed.
•SPK transplantation from donor’s with AKI can aid in expanding the donor pool.•AKI donors result in increased rates of DGF in SPK recipients.•However, no difference in eGFR at 1,3,6 and 12 month follow up was observed.•No difference in hemoglobin A1c at 3,6 and 12 month follow up was observed. |
| doi_str_mv | 10.1016/j.amjsurg.2020.09.031 |
| format | Article |
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59 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.
The 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).
We observed increased rates of DGF in SPK recipients with donor AKI. However, equivalent outcomes of pancreas and kidney function in both groups were observed.
•SPK transplantation from donor’s with AKI can aid in expanding the donor pool.•AKI donors result in increased rates of DGF in SPK recipients.•However, no difference in eGFR at 1,3,6 and 12 month follow up was observed.•No difference in hemoglobin A1c at 3,6 and 12 month follow up was observed.</description><identifier>ISSN: 0002-9610</identifier><identifier>EISSN: 1879-1883</identifier><identifier>DOI: 10.1016/j.amjsurg.2020.09.031</identifier><identifier>PMID: 33012501</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Adult ; Age ; Biomarkers - blood ; Biopsy ; Blood groups ; Creatinine ; Creatinine - blood ; Delayed graft function ; Demographics ; Diabetes ; Diabetes mellitus ; Diabetes Mellitus - surgery ; Donor acute kidney injury ; Donor Selection ; End-stage renal disease ; Female ; Glomerular Filtration Rate ; Glucose ; Graft function ; Graft Rejection ; Graft Survival ; Hemodialysis ; Hemoglobin ; Humans ; Insulin ; Kidney diseases ; Kidney Failure, Chronic - blood ; Kidney Failure, Chronic - surgery ; Kidney Transplantation ; Kidney transplants ; Male ; Pancreas ; Pancreas Transplantation ; Pancreas transplants ; Patients ; Peptides ; Retrospective Studies ; Simultaneous pancreas kidney transplantation ; Transplants</subject><ispartof>The American journal of surgery, 2021-04, Vol.221 (4), p.677-680</ispartof><rights>2020 Elsevier Inc.</rights><rights>Copyright © 2020 Elsevier Inc. All rights reserved.</rights><rights>2020. Elsevier Inc.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c393t-9c87a9794f6ae18f8f6048182eb2f5c439cbdf01ccec4b8d584cf8ea5f017ee03</citedby><cites>FETCH-LOGICAL-c393t-9c87a9794f6ae18f8f6048182eb2f5c439cbdf01ccec4b8d584cf8ea5f017ee03</cites><orcidid>0000-0002-2126-0720 ; 0000-0001-8270-2230 ; 0000-0003-3433-2209 ; 0000-0003-1341-5144</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2511199442?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3549,27923,27924,45994,64384,64386,64388,72340</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33012501$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Torabi, Julia</creatorcontrib><creatorcontrib>Melvin, Jeffrey</creatorcontrib><creatorcontrib>Rechnitzer, Alma</creatorcontrib><creatorcontrib>Rocca, Juan P.</creatorcontrib><creatorcontrib>Ajaimy, Maria</creatorcontrib><creatorcontrib>Lirano-Ward, Luz</creatorcontrib><creatorcontrib>Azzi, Yorg</creatorcontrib><creatorcontrib>Pynadath, Cindy</creatorcontrib><creatorcontrib>Alani, Omar</creatorcontrib><creatorcontrib>Akalin, Enver</creatorcontrib><creatorcontrib>Graham, Jay A.</creatorcontrib><title>High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation</title><title>The American journal of surgery</title><addtitle>Am J Surg</addtitle><description>Simultaneous 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.
59 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.
The 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).
We observed increased rates of DGF in SPK recipients with donor AKI. However, equivalent outcomes of pancreas and kidney function in both groups were observed.
•SPK transplantation from donor’s with AKI can aid in expanding the donor pool.•AKI donors result in increased rates of DGF in SPK recipients.•However, no difference in eGFR at 1,3,6 and 12 month follow up was observed.•No difference in hemoglobin A1c at 3,6 and 12 month follow up was observed.</description><subject>Adult</subject><subject>Age</subject><subject>Biomarkers - blood</subject><subject>Biopsy</subject><subject>Blood groups</subject><subject>Creatinine</subject><subject>Creatinine - blood</subject><subject>Delayed graft function</subject><subject>Demographics</subject><subject>Diabetes</subject><subject>Diabetes mellitus</subject><subject>Diabetes Mellitus - surgery</subject><subject>Donor acute kidney injury</subject><subject>Donor Selection</subject><subject>End-stage renal disease</subject><subject>Female</subject><subject>Glomerular Filtration Rate</subject><subject>Glucose</subject><subject>Graft function</subject><subject>Graft Rejection</subject><subject>Graft Survival</subject><subject>Hemodialysis</subject><subject>Hemoglobin</subject><subject>Humans</subject><subject>Insulin</subject><subject>Kidney diseases</subject><subject>Kidney Failure, Chronic - blood</subject><subject>Kidney Failure, Chronic - surgery</subject><subject>Kidney Transplantation</subject><subject>Kidney transplants</subject><subject>Male</subject><subject>Pancreas</subject><subject>Pancreas Transplantation</subject><subject>Pancreas transplants</subject><subject>Patients</subject><subject>Peptides</subject><subject>Retrospective Studies</subject><subject>Simultaneous pancreas kidney transplantation</subject><subject>Transplants</subject><issn>0002-9610</issn><issn>1879-1883</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUFv1DAQhS0EotvCTwBZ4sIlwRM7WfuEUAUtUiUucLa89qR1SOxgO5X67_FqFw5cOI1m9M2b0XuEvAHWAoPhw9SaZcpbum871rGWqZZxeEZ2IPeqASn5c7JjjHWNGoBdkMucp9oCCP6SXHDOoOsZ7Ii79fcPtGBafDAztQlN8cEHpC6GmDLND3GbHQ2x0DWhnTeHNPtlm4sJGLdMf3oX8Ima4OhqwlEg05JMyOtsQqlqMbwiL0YzZ3x9rlfkx5fP369vm7tvN1-vP901liteGmXl3qi9EuNgEOQox4EJCbLDQzf2VnBlD25kYC1acZCul8KOEk1fZ3tExq_I-5PumuKvDXPRi88W5_n0qu6EkIPo1NBX9N0_6BS3VC2oVA8ASgnRVao_UTbFnBOOek1-MelJA9PHGPSkzzHoYwyaKV1jqHtvz-rbYUH3d-uP7xX4eAKw2vHoMelsPQaLzleTi3bR_-fEb6BendA</recordid><startdate>202104</startdate><enddate>202104</enddate><creator>Torabi, Julia</creator><creator>Melvin, Jeffrey</creator><creator>Rechnitzer, Alma</creator><creator>Rocca, Juan P.</creator><creator>Ajaimy, Maria</creator><creator>Lirano-Ward, Luz</creator><creator>Azzi, Yorg</creator><creator>Pynadath, Cindy</creator><creator>Alani, Omar</creator><creator>Akalin, Enver</creator><creator>Graham, Jay A.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2O</scope><scope>MBDVC</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>Q9U</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-2126-0720</orcidid><orcidid>https://orcid.org/0000-0001-8270-2230</orcidid><orcidid>https://orcid.org/0000-0003-3433-2209</orcidid><orcidid>https://orcid.org/0000-0003-1341-5144</orcidid></search><sort><creationdate>202104</creationdate><title>High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation</title><author>Torabi, Julia ; Melvin, Jeffrey ; Rechnitzer, Alma ; Rocca, Juan P. ; Ajaimy, Maria ; Lirano-Ward, Luz ; Azzi, Yorg ; Pynadath, Cindy ; Alani, Omar ; Akalin, Enver ; Graham, Jay A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c393t-9c87a9794f6ae18f8f6048182eb2f5c439cbdf01ccec4b8d584cf8ea5f017ee03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adult</topic><topic>Age</topic><topic>Biomarkers - blood</topic><topic>Biopsy</topic><topic>Blood groups</topic><topic>Creatinine</topic><topic>Creatinine - blood</topic><topic>Delayed graft function</topic><topic>Demographics</topic><topic>Diabetes</topic><topic>Diabetes mellitus</topic><topic>Diabetes Mellitus - surgery</topic><topic>Donor acute kidney injury</topic><topic>Donor Selection</topic><topic>End-stage renal disease</topic><topic>Female</topic><topic>Glomerular Filtration Rate</topic><topic>Glucose</topic><topic>Graft function</topic><topic>Graft Rejection</topic><topic>Graft Survival</topic><topic>Hemodialysis</topic><topic>Hemoglobin</topic><topic>Humans</topic><topic>Insulin</topic><topic>Kidney diseases</topic><topic>Kidney Failure, Chronic - blood</topic><topic>Kidney Failure, Chronic - surgery</topic><topic>Kidney Transplantation</topic><topic>Kidney transplants</topic><topic>Male</topic><topic>Pancreas</topic><topic>Pancreas Transplantation</topic><topic>Pancreas transplants</topic><topic>Patients</topic><topic>Peptides</topic><topic>Retrospective Studies</topic><topic>Simultaneous pancreas kidney transplantation</topic><topic>Transplants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Torabi, Julia</creatorcontrib><creatorcontrib>Melvin, Jeffrey</creatorcontrib><creatorcontrib>Rechnitzer, Alma</creatorcontrib><creatorcontrib>Rocca, Juan P.</creatorcontrib><creatorcontrib>Ajaimy, Maria</creatorcontrib><creatorcontrib>Lirano-Ward, Luz</creatorcontrib><creatorcontrib>Azzi, Yorg</creatorcontrib><creatorcontrib>Pynadath, Cindy</creatorcontrib><creatorcontrib>Alani, Omar</creatorcontrib><creatorcontrib>Akalin, Enver</creatorcontrib><creatorcontrib>Graham, Jay A.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Research Library (Corporate)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Torabi, Julia</au><au>Melvin, Jeffrey</au><au>Rechnitzer, Alma</au><au>Rocca, Juan P.</au><au>Ajaimy, Maria</au><au>Lirano-Ward, Luz</au><au>Azzi, Yorg</au><au>Pynadath, Cindy</au><au>Alani, Omar</au><au>Akalin, Enver</au><au>Graham, Jay A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation</atitle><jtitle>The American journal of surgery</jtitle><addtitle>Am J Surg</addtitle><date>2021-04</date><risdate>2021</risdate><volume>221</volume><issue>4</issue><spage>677</spage><epage>680</epage><pages>677-680</pages><issn>0002-9610</issn><eissn>1879-1883</eissn><abstract>Simultaneous 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.
59 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.
The 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).
We observed increased rates of DGF in SPK recipients with donor AKI. However, equivalent outcomes of pancreas and kidney function in both groups were observed.
•SPK transplantation from donor’s with AKI can aid in expanding the donor pool.•AKI donors result in increased rates of DGF in SPK recipients.•However, no difference in eGFR at 1,3,6 and 12 month follow up was observed.•No difference in hemoglobin A1c at 3,6 and 12 month follow up was observed.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>33012501</pmid><doi>10.1016/j.amjsurg.2020.09.031</doi><tpages>4</tpages><orcidid>https://orcid.org/0000-0002-2126-0720</orcidid><orcidid>https://orcid.org/0000-0001-8270-2230</orcidid><orcidid>https://orcid.org/0000-0003-3433-2209</orcidid><orcidid>https://orcid.org/0000-0003-1341-5144</orcidid></addata></record> |
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| subjects | Adult Age Biomarkers - blood Biopsy Blood groups Creatinine Creatinine - blood Delayed graft function Demographics Diabetes Diabetes mellitus Diabetes Mellitus - surgery Donor acute kidney injury Donor Selection End-stage renal disease Female Glomerular Filtration Rate Glucose Graft function Graft Rejection Graft Survival Hemodialysis Hemoglobin Humans Insulin Kidney diseases Kidney Failure, Chronic - blood Kidney Failure, Chronic - surgery Kidney Transplantation Kidney transplants Male Pancreas Pancreas Transplantation Pancreas transplants Patients Peptides Retrospective Studies Simultaneous pancreas kidney transplantation Transplants |
| title | High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation |
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