Sofia Nehring Firmino, Ekaterina Fedorova, Eman A Alshaikh, Dixon Kaufman, Jon Odorico, Didier Mandelbrot, Brad C Astor, Sandesh Parajuli
{"title":"Kidney Delayed Graft Function in Simultaneous Pancreas-Kidney Transplant Recipients Is Associated With Inferior Outcomes.","authors":"Sofia Nehring Firmino, Ekaterina Fedorova, Eman A Alshaikh, Dixon Kaufman, Jon Odorico, Didier Mandelbrot, Brad C Astor, Sandesh Parajuli","doi":"10.1097/TXD.0000000000001797","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Kidney delayed graft function (K-DGF) is associated with worse outcomes in simultaneous pancreas-kidney (SPK) recipients. However, its potential association with specific infections, rejection, and early complications remains unclear.</p><p><strong>Methods: </strong>We compared recipients with K-DGF to those without K-DGF among all adult SPK recipients transplanted at our center between January 2000 and December 2022 who had >2 wk of pancreas graft survival. Outcomes of interest included common posttransplant infections, including urinary tract infection (UTI), pneumonia, cytomegalovirus, BK, surgical wound infection, infected intra-abdominal fluid collection, graft rejection, and death-censored graft failure (DCGF) within the first year of transplant. We also looked for the need for early laparotomy within 90 d.</p><p><strong>Results: </strong>Seven hundred sixty-five SPK recipients were included, of whom 85 (11.1%) developed K-DGF. In Cox regression analysis, after adjustment for multiple key variables, K-DGF was associated/related with increased risk for UTI (adjusted hazard ratio [aHR], 1.76; 95% confidence interval [CI], 1.06-0.94; <i>P</i> = 0.03), infected intra-abdominal fluid collection (aHR, 2.14; 95% CI, 1.13-4.04; <i>P</i> = 0.02), and need for relaparotomy within 90 d (aHR, 2.07; 95% CI, 1.27-3.37; <i>P</i> = 0.003). K-DGF was also associated with increased risk for pancreas DCGF (aHR, 4.88; 95% CI, 1.90-12.51; <i>P</i> < 0.001). K-DGF was not associated with risk for other common infections of interest or graft rejection.</p><p><strong>Conclusions: </strong>K-DGF among SPK recipients is associated with an increased risk of UTI, infected intra-abdominal fluid collection, and the need for early relaparotomy, along with pancreas DCGF. Close monitoring and appropriate management are warranted in this higher-risk patient population.</p>","PeriodicalId":23225,"journal":{"name":"Transplantation Direct","volume":"11 5","pages":"e1797"},"PeriodicalIF":1.9000,"publicationDate":"2025-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12007875/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Transplantation Direct","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1097/TXD.0000000000001797","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/5/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"TRANSPLANTATION","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Kidney delayed graft function (K-DGF) is associated with worse outcomes in simultaneous pancreas-kidney (SPK) recipients. However, its potential association with specific infections, rejection, and early complications remains unclear.
Methods: We compared recipients with K-DGF to those without K-DGF among all adult SPK recipients transplanted at our center between January 2000 and December 2022 who had >2 wk of pancreas graft survival. Outcomes of interest included common posttransplant infections, including urinary tract infection (UTI), pneumonia, cytomegalovirus, BK, surgical wound infection, infected intra-abdominal fluid collection, graft rejection, and death-censored graft failure (DCGF) within the first year of transplant. We also looked for the need for early laparotomy within 90 d.
Results: Seven hundred sixty-five SPK recipients were included, of whom 85 (11.1%) developed K-DGF. In Cox regression analysis, after adjustment for multiple key variables, K-DGF was associated/related with increased risk for UTI (adjusted hazard ratio [aHR], 1.76; 95% confidence interval [CI], 1.06-0.94; P = 0.03), infected intra-abdominal fluid collection (aHR, 2.14; 95% CI, 1.13-4.04; P = 0.02), and need for relaparotomy within 90 d (aHR, 2.07; 95% CI, 1.27-3.37; P = 0.003). K-DGF was also associated with increased risk for pancreas DCGF (aHR, 4.88; 95% CI, 1.90-12.51; P < 0.001). K-DGF was not associated with risk for other common infections of interest or graft rejection.
Conclusions: K-DGF among SPK recipients is associated with an increased risk of UTI, infected intra-abdominal fluid collection, and the need for early relaparotomy, along with pancreas DCGF. Close monitoring and appropriate management are warranted in this higher-risk patient population.