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Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study.

ABSTRACT: Background:Sarcopenia has been identified as a predictive variable for surgical outcomes. We hypothesized that sarcopenia could be a key measure to identify frail patients and potentially predict poorer outcomes among recipients of simultaneous pancreas and kidney (SPK) transplants. Methods:We estimated sarcopenia by measuring psoas muscle mass index (PMI). PMI was assessed on perioperative computed tomography (CT) scans of SPK recipients. Results:Of the 141 patients identified between 2010 and 2018, 107 had a CT scan available and were included in the study. The median follow-up was 4 years (range, 0.5-9.1 y). Twenty-three patients had a low PMI, and 84 patients had a normal PMI. Patient characteristics were similar between the 2 groups except for body mass index, which was significantly lower in low PMI group (P?

SUBMITTER: Meier RPH

PROVIDER: S-EPMC7523826 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study.

Meier Raphael P H RPH Noguchi Hiroshi H Kelly Yvonne M YM Sarwal Minnie M Conti Giulia G Ward Casey C Halleluyan Ran R Tavakol Mehdi M Stock Peter G PG Freise Chris E CE

Transplantation direct 20200925 10

<h4>Background</h4>Sarcopenia has been identified as a predictive variable for surgical outcomes. We hypothesized that sarcopenia could be a key measure to identify frail patients and potentially predict poorer outcomes among recipients of simultaneous pancreas and kidney (SPK) transplants.<h4>Methods</h4>We estimated sarcopenia by measuring psoas muscle mass index (PMI). PMI was assessed on perioperative computed tomography (CT) scans of SPK recipients.<h4>Results</h4>Of the 141 patients identi ...[more]

PMID: 33062843

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Project description:Background and objectivesHistorically, length of pretransplant dialysis was associated with premature graft loss and mortality after kidney transplantation, but with recent advancements in RRT it is unclear whether this negative association still exists.Design, setting, participants, &measurementsThis is a retrospective cohort study evaluating 6979 first kidney allograft recipients from the Austrian Registry transplanted between 1990 and 2013. Duration of pretransplant dialysis treatment was used as categoric predictor classified by tertiles of the distribution of time on dialysis. A separate category for pre-emptive transplantation was added and defined as kidney transplantation without any dialysis preceding the transplant. Outcomes were death-censored graft loss, all-cause mortality, and the composite of both.ResultsMedian duration of follow-up was 8.2 years, and 1866 graft losses and 2407 deaths occurred during the study period. Pre-emptive transplantation was associated with a lower risk of graft loss (hazard ratio, 0.76; 95% confidence interval, 0.59 to 0.98), but not in subgroup analyses excluding living transplants and transplants performed since 2000. The association between dialysis duration and graft loss did not depend on the year of transplantation (P=0.40) or donor source (P=0.92). Longer waiting time on dialysis was not associated with a higher rate of graft loss, but the rate of death was higher in patients on pretransplant dialysis for >1.5 years (hazard ratio, 1.62; 95% confidence interval, 1.43 to 1.83) compared with pretransplant dialysis for <1.5 years.ConclusionsOur findings support the evidence that pre-emptive transplantation is associated with superior graft survival compared with pretransplant dialysis, although this association was weaker in transplants performed since 2000. However, our analysis shows that length of dialysis was no longer associated with a higher rate of graft loss, although longer waiting times on dialysis were still associated with a higher rate of death.

Project description:BackgroundSimultaneous kidney-pancreas transplantation (SPK) has benefits for patients with kidney failure and type I diabetes mellitus, but is associated with greater perioperative risk compared with kidney-alone transplantation. Postoperative care settings for SPK recipients vary across Canada and may have implications for patient outcomes and hospital resource use.ObjectiveTo compare outcomes following SPK transplantation between patients receiving postoperative care in the intensive care unit (ICU) compared with the ward.DesignRetrospective cohort study using administrative health data.SettingIn Alberta, the 2 transplant centers (Calgary and Edmonton) have different protocols for routine postoperative care of SPK recipients. In Edmonton, SPK recipients are routinely transferred to the ICU, whereas in Calgary, SPK recipients are transferred to the ward.Patients129 adult SPK recipients (2002-2019).MeasurementsData from the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) were used to identify SPK recipients (procedure codes) and the outcomes of inpatient mortality, length of initial hospital stay (LOS), and the occurrence of 16 different patient safety indicators (PSIs).MethodsWe followed SPK recipients from the admission date of their transplant hospitalization until the first of hospital discharge or death. Unadjusted quantile regression was used to determine differences in LOS, and age- and sex-adjusted marginal probabilities were used to determine differences in PSIs between centers.ResultsThere were no perioperative deaths and no major differences in the demographic characteristics between the centers. The majority of the SPK transplants were performed in Edmonton (n = 82, 64%). All SPK recipients in Edmonton were admitted to the ICU postoperatively, compared with only 11% in Calgary. There was no statistically significant difference in the LOS or probability of a PSI between the 2 centers (LOS for Edmonton vs Calgary:16 vs 13 days, P = .12; PSIs for Edmonton vs Calgary: 60%, 95% confidence interval [CI] = 0.50-0.71 vs 44%, 95% CI = 0.29-0.59, P = .08).LimitationsThis study was conducted using administrative data and is limited by variable availability. The small sample size limited precision of estimated differences between type of postoperative care.ConclusionsFollowing SPK transplantation, we found no difference in inpatient outcomes for recipients who received routine postoperative ICU care compared with ward care. Further research using larger data sets and interventional study designs is needed to better understand the implications of postoperative care settings on patient outcomes and health care resource utilization.

Project description:BackgroundPancreas transplant alone (PTA) recipients are more affected by pancreas graft thrombosis, and graft loss compared to simultaneous pancreas-kidney (SPK) recipients. The pathophysiology is unknown, but an increased immune response has been suggested in the PTA recipients. In this observational study, we compared perioperative thromboinflammation between PTA (n=32) and SPK (n=35) recipients, and between PTA recipients with (n=14) versus without (n=18) early graft thrombosis.MethodsWe measured C-reactive protein (CRP), plasma markers of activated coagulation and complement, and cytokines preoperatively and daily during the first postoperative week.ResultsPreoperatively, coagulation and complement activation markers were comparable between PTA and SPK recipients, while cytokine concentrations were higher in SPK recipients (TNF, IL-8, IP-10, MCP-1, MIP-1α; all p<0.05). On the first postoperative day, PTA recipients had higher coagulation activation, measured as thrombin-antithrombin complex (TAT), than SPK recipients (p=0.008). In the first postoperative week, PTA recipients showed higher relative cytokine release (IL-6, IL-8, G-CSF, IP-10, MCP-1, and MIP-1α; all p<0.05) while SPK recipients showed higher absolute cytokine concentrations (TNF, IL-1ra, IL-8, MIP-1α, and IL-4; all p<0.05). PTA and SPK recipients showed similar terminal complement complex (TCC, sC5b-9) activation. On the first postoperative day, TCC (OR 1.2 [95% CI 1.0-1.5] for 0.1 CAU/ml increase, p=0.02) and CRP (OR 1.2 [95% CI 1.0-1.3] for 10 mg/L increase, p=0.04) were associated with an increased risk of early graft thrombosis. TCC was specific for graft thrombosis, while CRP increased with several complications. PTA recipients with compared to those without graft thrombosis had higher TCC pre- (p=0.04) and postoperatively (p=0.03).ConclusionThe relative increase in postoperative thromboinflammatory response was more pronounced in PTA recipients. Complement activation was associated with an increased risk of graft thrombosis. This study indicates that innate immune activation rather than elevated levels may affect early postoperative pancreas graft thrombosis.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/NCT01957696, identifier NCT01957696.

Dataset Information

Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study.

Publications

Impact of Sarcopenia on Simultaneous Pancreas and Kidney Transplantation Outcomes: A Retrospective Observational Cohort Study.

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