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 Scopus citations

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

Keywords

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

ASJC Scopus subject areas

  • Immunology

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