Analysis of the results of pancreas transplantation in one transplant center in Russia

Introduction. The total number of pancreas transplantations performed in Russia by the end of 2019 had been 176. There are no detailed reports on the number and results of pancreas transplantation in Russia with analysis of factors that significantly affect outcomes.
Material and methods. This article presents a retrospective analysis of 60 pancreas transplantation results, which had been performed from January 2008 to July 2019 at the N.V. Sklifosovsky Research Institute for Emergency Medicine. In addition, the assessment of factors that significantly affect the outcomes of pancreas transplantations was performed.
Results. 17 intra-abdominal pancreas transplantations with duodenoejunoanastomosis and 43 retroperitoneal pancreas transplantations with interduodenal anastomosis were performed. In 52 patients, the pancreas graft after vascular reconstruction with a Y-shaped vascular prosthesis was used; in other 8 patients, the pancreas graft with isolated blood flow through the splenic artery was used. The rates of immunological and surgical complications were 23.3% and 56.7%, respectively. In-hospital and 1-year recipient, kidney and pancreas graft survival rates were 88.3%, 86.4%, 83.3% and 86.6%, 84.8%, and 81.7%, respectively. The factors that significantly affected the outcomes of pancreas transplantation were the conversion of the dialysis therapy modality, the development of parapancreatic infection, repeated open surgical interventions, surgical complications of IIIb-IVa severity grades by Clavien-Dindo Classification, some features of basic and induction immunosuppressive therapy.
Conclusion. The results of pancreas transplantation at the N.V. Sklifosovsky Research Institute for Emergency Medicine are comparable to the outcomes of pancreas transplantation in most world transplant centers.

1. Gruessner RWG, Sutherland DER, (eds.) Transplantation of the pancreas. NewYork: Springer; 2004.

2. Corry RJ, Shapiro R, (eds.) Pancreatic transplantation. New York: Informa Healthcare; 2007. p. 159–170.

3. Gruessner AC, Gruessner RWG. Pancreas Transplantation for Patients with Type 1 and Type 2 Diabetes Mellitus in the United States: A Registry Report. Gastroenterol Clin North Am. 2018;47(2):417–441. PMID: 29735033 https://doi.org/10.1016/j.gtc.2018.01.009

4. Sandrikov VA, Zokoev AK, Babenko NN, Minina MG, Gulyaev VA, Platova EN, et al. Combined kidney-pancreas transplantation from deceased donor. Russian Journal of Transplantology and Artificial Organs. 2006;(3):4–9. (In Russ.).

5. Kandaswamy R, Stock PG, Gustafson SK, Skeans MA, Urban R, Fox A, et al. OPTN/SRTR 2018 Annual Data Report: Pancreas. Am J Transplant. 2020;20 (Suppl 1):131–192. PMID: 31898415 https://doi.org/10.1111/ajt.15673

6. Gautier SV, Khomyakov SM. Organ donation and transplantation in the Russian Federation in 2019. 12th report from the Registry of the Russian Transplant Society. Russian Journal of Transplantology and Artificial Organs. 2020;22(2):8–34. (In Russ.). https://doi.org/10.15825/1995-1191-2020-2-8-34

7. Rangel EB, Melaragno CS, Gonzalez AM, Linhares MM, de Sá JR, Salzedas A, et al. Delayed kidney allograft function after simultaneous pancreaskidney transplantation. Transplant Proc. 2010;42(9):3655–3659. PMID: 21094834 https://doi.org/10.1016/j.transproceed.2010.06.030

8. Page M, Rimmelé T, Ber CE, Christin F, Badet L, Morelon E, et al. Early relaparotomy after simultaneous pancreas-kidney transplantation. Transplantation. 2012;94(2):159–164. PMID: 22728293 https://doi.org/10.1097/TP.0b013e318254dae1

9. Reddy KS, Stablein D, Taranto S, Stratta RJ, Johnston TD, Waid TH, et al. Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis. 2003;41(2):464–470. PMID: 12552511 https://doi.org/10.1053/ajkd.2003.50057

10. Ito T, Kenmochi T, Aida N, Kurihara K, Asaoka T, Ito T. Are the outcomes of Japanese pancreas transplantation utilizing extended-criteria donors acceptable? A propensity score matching analysis for donors <50 or >50 years old. Transpl Int. 2020;33(9):1046–1060. PMID: 32394519 https://doi.org/10.1111/tri.13636

11. Lindahl JP, Hartmann A, Horneland R, Holdaas H, Reisæter AV, Midtvedt K, et al. Improved patient survival with simultaneous pancreas and kidney transplantation in recipients with diabetic end-stage renal disease. Diabetologia. 2013;56(6):1364–1371. PMID: 23549518 https://doi.org/10.1007/s00125-013-2888-y

12. Durlik M, Baumgart-Gryn K. Almost 200 pancreas transplantations: a singlecenter experience. Transplant Proc. 2018;50(7):2124–2127. PMID: 30177122 https://doi.org/10.1016/j.transproceed.2018.02.097

13. Franz C, Görtz M, Wührl M, Kulu Y, Hoffmann K, Hackert T, et al. The Role of pre-procurement pancreas suitability score (P-PASS) and pancreas donor risk index (PDRI) in the outcome of simultaneous pancreas and kidney or pancreas after kidney transplantation. Ann Transplant. 2019;24:439–445. PMID: 31346153 https://doi.org/10.12659/AOT.915852

14. Shah AP, Chen JM, Fridell JA. Incidence and outcomes of cytomegalovirus in pancreas transplantation with steroidfree immunosuppression. Clin Transplant. 2015;29(12):1221–1229. PMID: 26458498 https://doi.org/10.1111/ctr.12655

15. Foltys DB, Kaths JM, Zimmermann T, Heise M, Hoppe-Lotichius M, Otto G. Ten years of simultaneous pancreas-kidney transplantation: a retrospective singlecenter analysis of prospectively obtained data. Transplant Proc. 2011;43(9):3267–3269. PMID: 22099773 https://doi.org/10.1016/j.transproceed.2011.09.099

16. McCullough KP, Keith DS, Meyer KH, Stock PG, Brayman KL, Leichtman AB. Kidney and pancreas transplantation in the United States, 1998–2007: access for patients with diabetes and end-stage renal disease. Am J Transplant. 2009;9(4Pt2):894–906. PMID: 19341414 https://doi.org/10.1111/j.1600-6143.2009.02566.x

17. Bodro M, Ferrer J, Ricart MJ, Sanclemente G, Linares L, Cervera C, et al. Epidemiology, risk factors, and impact of bacterial infections on outcomes for pancreatic grafts. Clin Transplant. 2018;32(8):e13333. PMID: 29920780 https://doi.org/10.1111/ctr.13333

18. Marcacuzco A, Jiménez-Romero C, Manrique A, Calvo J, Cambra F, Caso Ó, et al. Outcome of patients with hemodialysis or peritoneal dialysis undergoing simultaneous pancreas-kidney transplantation. Comparative study. Clin Transplant. 2018;32(6):e13268. PMID: 29683218 https://doi.org/10.1111/ctr.13268

19. Messner F, Etra JW, Haugen CE, Bösmüller C, Maglione M, Hackl H, et al. Sex matching does not impact the outcome after simultaneous pancreaskidney transplantation. Clin Transplant. 2019;33(11):e13717. PMID: 31545525 https://doi.org/10.1111/ctr.13717

20. Venstrom JM, McBride MA, Rother KI, Hirshberg B, Orchard TJ, Harlan DM. Survival after pancreas transplantation in patients with diabetes and preserved kidney function. JAMA. 2003;290(21):2817–2823. PMID: 14657065 https://doi.org/10.1001/jama.290.21.2817

21. Serrano OK, Vock DM, Dunn TB, Kandaswamy R, Finger EB. Maximizing utilization in pancreas transplantation: phenotypic characteristics differentiating aggressive from nonaggressive transplant centers. Transplantation. 2018;102(12):2108–2119. PMID: 29944617 https://doi.org/10.1097/TP.0000000000002334

22. Parajuli S, Muth BL, Astor BC, Redfield RR, Mandelbrot DA, Odorico JS, et al. Delayed kidney graft function in simultaneous pancreas-kidney transplant recipients is associated with early pancreas allograft failure. Am J Transplant. 2020;20(10):2822–2831. PMID: 32306520 https://doi.org/10.1111/ajt.15923