A clinical case of successful treatment of surgical site infection in a kidney and pancreas recipient

Background. Surgical site infections (SSIs) following solid organ transplantation pose grave risks, including the potential loss of the transplanted organ and mortality of the recipient. The management of these infections is highly intricate and necessitates ongoing research and the refinement of treatment protocols to enhance outcomes.

The objective of this study is to illustrate a successful treatment approach for retroperitoneal infection in the surgical area following combined kidney and pancreas transplantation, with a particular focus on the region where the pancreas graft is located.

Material and methods. A 31-year-old female recipient of a kidney and pancreas transplant was diagnosed with type 1 diabetes mellitus, complicated by diabetic nephropathy, which had progressed to a terminal stage of chronic kidney disease. The clinical case was described using data from the recipient's medical history, observation card, and organ passport, along with the results of general clinical and instrumental investigations.

Results. The clinical picture of the course of bacterial infection of the retroperitoneal space in the area of pancreas graft location and its successful treatment in a recipient after simultaneous pancreas and kidney transplantation is presented. Due to the choice of optimal treatment tactics, it was possible not only to avoid the development of sepsis, but also to preserve the function of both grafts.

Conclusion. The development of SSIs in the form of retroperitoneal infection in a recipient without primary infection of the pancreas graft, in the context of adequate surgical intervention, in conjunction with etiotropic antimicrobial therapy and a reduction in immunosuppression, is a condition that can be effectively treated, resulting in a positive outcome for the recipient.

1. Deng Y, Li N, Wu Y, Wang M, Yang S, Zheng Y, et al. Global, regional, and national burden of diabetes-related chronic kidney disease from 1990 to 2019. Front Endocrinol (Lausanne). 2021;12:672350. PMID: 34276558 https://doi.org/10.3389/fendo.2021.672350

2. Jha R, Lopez-Trevino S, Kankanamalage HR, Jha JC. Diabetes and renal complications: an overview on pathophysiology, biomarkers and therapeutic interventions. Biomedicines. 2024;12(5):1098. PMID: 38791060 https://doi.org/10.3390/biomedicines12051098

3. Khubutia MSh, Pinchuk AV, Dmitriev IV, Lazareva KE, Balkarov AG, Storozhev RV, et al. Simultaneous pancreas-kidney transplantation: early postoperative complications. Russian Journal of Transplantology and Artificial Organs. 2014;16(2):24–29. (In Russ.).

4. Nagendra L, Fernandez CJ, Pappachan JM. Simultaneous pancreas-kidney transplantation for end-stage renal failure in type 1 diabetes mellitus: current perspectives. World J Transplant. 2023;13(5):208–220. PMID: 37746036 https://doi.org/10.5500/wjt.v13.i5.208

5. Martin D, Alberti P, Demartines N, Phillips M, Casey J, Sutherland A. Whole-organ pancreas and islets transplantations in UK: an overview and future directions. J Clin Med. 2023;12(9):3245. PMID: 37176684 https://doi.org/10.3390/jcm12093245

6. Zhuravel NS, Balkarov AG, Dmitriev IV, Shmarina NV, Lazareva KE, Anisimov YuA, et al. Sochetannaya transplantatsiya pochki i podzheludochnoy zhelezy: 16-letniy opyt NII SP imeni N.V. Sklifosovskogo. Russian Journal of Transplantology and Artificial Organs. 2024;26(S):117. (In Russ.). https://doi.org/10.15825/1995-1191-2024-S-117

7. Vidal Crespo N, López Cubillana P, López González PA, Alarcón CM, Hernández JR, Martínez LA, et al. Simultaneous pancreas-kidney transplantation: early complications and long-term outcomes - a single-center experience. Can Urol Assoc J. 2022;16(7):E357–E362. PMID: 35230938 https://doi.org/10.5489/cuaj.7635

8. King EA, Kucirka LM, McAdams-DeMarco MA, Massie AB, Al Ammary F, Ahmed R, et al. Early hospital readmission after simultaneous pancreas-kidney transplantation: patient and center-level factors. Am J Transplant. 2016;16(2):541– 549. PMID: 26474070 https://doi.org/10.1111/ajt.13485

9. Schreiber PW, Laager M, Boggian K, Neofytos D, van Delden C, Egli A, et al. Surgical site infections after simultaneous pancreas kidney and pancreas transplantation in the Swiss Transplant Cohort Study. J Hosp Infect. 2022;128:47–53. PMID: 35840001 https://doi.org/10.1016/j.jhin.2022.07.009

10. Sartelli M, Coccolini F, Kluger Y, Agastra E, Abu-Zidan FM, Sayed AEl, et al. WSES/GAIS/WSIS/SIS-E/AAST global clinical pathways for patients with skin and soft tissue infections. World J Emerg Surg. 2022;17(1):3. PMID: 35033131 https://doi.org/10.1186/s13017-022-00406-2

11. Zabaglo M, Leslie SW, Sharman T. Postoperative wound infections. Stat-Pearls Publishing; 2025. PMID: 32809368

12. Silva JT, Fernandez-Ruiz M, Aguado JM. Multidrug-resistant gram-negative infection in solid organ transplant recipients: implications for outcome and treatment. Curr Opin Infect Dis. 2018;31(6):499–505. PMID: 30299353 https://doi.org/10.1097/QCO.0000000000000488

13. Freire MР, Pouch S, Manesh A, Giannella M. Burden and management of multi-drug resistant organism infections in solid organ transplant recipients across the world: a narrative review. Transplant Int. 2024;37:12469. PMID: 38952482 https://doi.org/10.3389/ti.2024.12469

14. Cardoso C, Bravo P, Messias A, Martins J, Oliveira C. Prophylaxis in kidney transplantation. Braz J Transpl. 2024;27:e3324. https://doi.org/10.53855/bjt.v27i1.608_ENG

15. Schreiber PW, Hoessly LD, Boggian K, Neofytos D, van Delden C, Egli A, et al. Surgical site infections after kidney transplantation are independently associated with graft loss. Am J Transplant. 2024;24(5):795–802. PMID: 38042413 https://doi.org/10.1016/j.ajt.2023.11.013

16. Gelfand BR, Kubyshkin VA, Kozlov RS, Khachatryan NN. (eds.) Khirurgicheskie infektsii kozhi i myagkikh tkaney. Rossiyskie natsional'nye rekomendatsii. 2nd ed., revised and enlarged. Moscow: Izdatel'stvo MAI Publ.; 2015. (In Russ.).

17. Zhuravel NS. Zabryushinnaya transplantatsiya podzheludochnoy zhelezy s kishechnym drenirovaniem pankreaticheskogo soka: Cand. med. sci. diss. Moscow; 2024. Available at: https://www.dissercat.com/content/zabryushinnaya-transplantatsiya-podzheludochnoizhelezy-s-kishechnym-drenirovaniempankreati [Accessed July 1, 2024]. (In Russ.).

18. Yetmar ZA, McCord M, Lahr BD, Kudva YC, Seville MT, Bosch W, et al. Impact of perioperative prophylaxis with enterococcus activity on risk of surgical-site infection after pancreas transplantation. Transplant Direct. 2023;9(7):e1496. PMID: 37305653 https://doi.org/10.1097/TXD.0000000000001496

19. Kalil AC, Dakroub H, Freifeld AG. Sepsis and solid organ transplantation. Curr Drug Targets. 2007;8(4):533-541. PMID: 17430124 https://doi.org/10.2174/138945007780362746

20. Kulabukhov VV, Zubareva NA, Yartsev PA. Sepsis: source control. Messenger of anesthesiology and resuscitation. 2021;18(5):89–96. (In Russ.). https://doi.org/10.21292/2078-5658-2021-18-5-89-96

21. Abbo LM, Grossi PA. Surgical site infections: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019;33(9):e13589. PMID: 31077619 https://doi.org/10.1111/ctr.13589