Impact of Portal Venous Pancreas Graft Drainage on Kidney Graft Outcome in Simultaneous Pancreas-Kidney Recipients Reported to UNOS

Christoph Troppmann, David W. Gjertson, J. Michael Cecka, John McVicar, Richard V Perez

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Clinical data on the potential immunologic impact of portal (PD) vs. systemic (SD) venous pancreas graft drainage on outcome remains controversial. We reviewed the UNOS database to study the effect of PD vs. SD on the incidence of kidney graft rejection and survival in first cadaveric simultaneous pancreas-kidney (SPK) recipients transplanted 1994-2001. We studied three groups: all SPK (n = 6629, 13% PD) (group I), SPK on tacrolimus (n = 3563, 17% PD) (group II), and SPK on tacrolimus performed at centers with significant PD experience (n = 948, 46% PD) (group III). The cumulative kidney graft rejection incidence for PD vs. SD was only significantly different in group I (for PD vs. SD, respectively: at 6 months, 31% vs. 36% [p = 0.0151; at 1 year, 37% vs. 43% [p = 0.0061]). Kidney graft survival was similar in all groups for PD vs. SD. Multivariate analysis of group III showed only transplantation during the earlier era (1994-96), but not SD, to be an independent risk factor for kidney graft rejection. Portal venous pancreas graft drainage does not affect kidney graft rejection and survival in SPK recipients on tacrolimus. Our data suggests that the efficacy of current immunosuppressive protocols and increasing center experience are clinically much more relevant than any potential immunologic advantage of portal venous drainage in SPK recipients.

Original languageEnglish (US)
Pages (from-to)544-553
Number of pages10
JournalAmerican Journal of Transplantation
Volume4
Issue number4
DOIs
StatePublished - Apr 2004

Fingerprint

Drainage
Pancreas
Transplants
Kidney
Graft Rejection
Tacrolimus
Graft Survival
Incidence
Immunosuppressive Agents
Multivariate Analysis
Transplantation
Databases

Keywords

  • Kidney graft rejection
  • Kidney graft survival
  • Kidney transplantation
  • Pancreas transplantation
  • Portal tolerance
  • Portal venous drainage

ASJC Scopus subject areas

  • Immunology

Cite this

@article{96625312a0c94455a949dfca3fc6d200,
title = "Impact of Portal Venous Pancreas Graft Drainage on Kidney Graft Outcome in Simultaneous Pancreas-Kidney Recipients Reported to UNOS",
abstract = "Clinical data on the potential immunologic impact of portal (PD) vs. systemic (SD) venous pancreas graft drainage on outcome remains controversial. We reviewed the UNOS database to study the effect of PD vs. SD on the incidence of kidney graft rejection and survival in first cadaveric simultaneous pancreas-kidney (SPK) recipients transplanted 1994-2001. We studied three groups: all SPK (n = 6629, 13{\%} PD) (group I), SPK on tacrolimus (n = 3563, 17{\%} PD) (group II), and SPK on tacrolimus performed at centers with significant PD experience (n = 948, 46{\%} PD) (group III). The cumulative kidney graft rejection incidence for PD vs. SD was only significantly different in group I (for PD vs. SD, respectively: at 6 months, 31{\%} vs. 36{\%} [p = 0.0151; at 1 year, 37{\%} vs. 43{\%} [p = 0.0061]). Kidney graft survival was similar in all groups for PD vs. SD. Multivariate analysis of group III showed only transplantation during the earlier era (1994-96), but not SD, to be an independent risk factor for kidney graft rejection. Portal venous pancreas graft drainage does not affect kidney graft rejection and survival in SPK recipients on tacrolimus. Our data suggests that the efficacy of current immunosuppressive protocols and increasing center experience are clinically much more relevant than any potential immunologic advantage of portal venous drainage in SPK recipients.",
keywords = "Kidney graft rejection, Kidney graft survival, Kidney transplantation, Pancreas transplantation, Portal tolerance, Portal venous drainage",
author = "Christoph Troppmann and Gjertson, {David W.} and Cecka, {J. Michael} and John McVicar and Perez, {Richard V}",
year = "2004",
month = "4",
doi = "10.1111/j.1600-6143.2004.00378.x",
language = "English (US)",
volume = "4",
pages = "544--553",
journal = "American Journal of Transplantation",
issn = "1600-6135",
publisher = "Wiley-Blackwell",
number = "4",

}

TY - JOUR

T1 - Impact of Portal Venous Pancreas Graft Drainage on Kidney Graft Outcome in Simultaneous Pancreas-Kidney Recipients Reported to UNOS

AU - Troppmann, Christoph

AU - Gjertson, David W.

AU - Cecka, J. Michael

AU - McVicar, John

AU - Perez, Richard V

PY - 2004/4

Y1 - 2004/4

N2 - Clinical data on the potential immunologic impact of portal (PD) vs. systemic (SD) venous pancreas graft drainage on outcome remains controversial. We reviewed the UNOS database to study the effect of PD vs. SD on the incidence of kidney graft rejection and survival in first cadaveric simultaneous pancreas-kidney (SPK) recipients transplanted 1994-2001. We studied three groups: all SPK (n = 6629, 13% PD) (group I), SPK on tacrolimus (n = 3563, 17% PD) (group II), and SPK on tacrolimus performed at centers with significant PD experience (n = 948, 46% PD) (group III). The cumulative kidney graft rejection incidence for PD vs. SD was only significantly different in group I (for PD vs. SD, respectively: at 6 months, 31% vs. 36% [p = 0.0151; at 1 year, 37% vs. 43% [p = 0.0061]). Kidney graft survival was similar in all groups for PD vs. SD. Multivariate analysis of group III showed only transplantation during the earlier era (1994-96), but not SD, to be an independent risk factor for kidney graft rejection. Portal venous pancreas graft drainage does not affect kidney graft rejection and survival in SPK recipients on tacrolimus. Our data suggests that the efficacy of current immunosuppressive protocols and increasing center experience are clinically much more relevant than any potential immunologic advantage of portal venous drainage in SPK recipients.

AB - Clinical data on the potential immunologic impact of portal (PD) vs. systemic (SD) venous pancreas graft drainage on outcome remains controversial. We reviewed the UNOS database to study the effect of PD vs. SD on the incidence of kidney graft rejection and survival in first cadaveric simultaneous pancreas-kidney (SPK) recipients transplanted 1994-2001. We studied three groups: all SPK (n = 6629, 13% PD) (group I), SPK on tacrolimus (n = 3563, 17% PD) (group II), and SPK on tacrolimus performed at centers with significant PD experience (n = 948, 46% PD) (group III). The cumulative kidney graft rejection incidence for PD vs. SD was only significantly different in group I (for PD vs. SD, respectively: at 6 months, 31% vs. 36% [p = 0.0151; at 1 year, 37% vs. 43% [p = 0.0061]). Kidney graft survival was similar in all groups for PD vs. SD. Multivariate analysis of group III showed only transplantation during the earlier era (1994-96), but not SD, to be an independent risk factor for kidney graft rejection. Portal venous pancreas graft drainage does not affect kidney graft rejection and survival in SPK recipients on tacrolimus. Our data suggests that the efficacy of current immunosuppressive protocols and increasing center experience are clinically much more relevant than any potential immunologic advantage of portal venous drainage in SPK recipients.

KW - Kidney graft rejection

KW - Kidney graft survival

KW - Kidney transplantation

KW - Pancreas transplantation

KW - Portal tolerance

KW - Portal venous drainage

UR - http://www.scopus.com/inward/record.url?scp=1942469987&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=1942469987&partnerID=8YFLogxK

U2 - 10.1111/j.1600-6143.2004.00378.x

DO - 10.1111/j.1600-6143.2004.00378.x

M3 - Article

C2 - 15023146

AN - SCOPUS:1942469987

VL - 4

SP - 544

EP - 553

JO - American Journal of Transplantation

JF - American Journal of Transplantation

SN - 1600-6135

IS - 4

ER -