Challenges associated with pancreas and kidney retransplantation

Simultaneous pancreas and kidney transplantation (SPK) is an accepted treatment for diabetic patients with renal failure, and is associated with increased survival and quality of life for recipients. There are only a few publications on the outcomes of simultaneous pancreas–kidney retransplantation (Re-SPK) after previous SPK and the loss of function of both grafts. A total of 55 patients with type 1 diabetes mellitus underwent pancreas retransplantation at our center between January 1994 and March 2021. Twenty-four of these patients underwent Re-SPK after a previous SPK. All 24 operations were technically feasible. Patient survival rate after 3 months, 1 year, and 5 years was 79.2%, 75%, and 66.7%, respectively. The causes of death were septic arterial hemorrhage ($\it n$ = 3), septic multiorgan failure ($\it n$ = 2), and was unknown in one patient. Pancreas and kidney graft function after 3 months, 1 year, and 5 years were 70.8% and 66.7%, 66.7% and 62.5%, and 45.8% and 54.2%, respectively. Relaparotomy was performed in 13 out of 24 (54.2%) patients. The results of our study show that Re-SPK, after previously performed SPK, is a technical and immunological challenge, associated with a significantly increased mortality and complication rate; therefore, the indication for Re-SPK should be very strict. Careful preoperative diagnosis is indispensable

Impact of donor cardiopulmonary resuscitation on the outcome of simultaneous pancreas–kidney transplantation

Previous cardiac arrest in brain‐dead donors has been discussed as a potential risk factor in pancreas transplantation (PT), leading to a higher rate of organ refusal. This study aimed to assess the impact of cardiopulmonary resuscitation (CPR) in brain‐dead donors on pancreas transplant outcome. A total of 518 type 1 diabetics underwent primary simultaneous pancreas–kidney (SPK) transplantation at our center between 1994 and 2018. Patients were divided into groups, depending on whether their donor had been resuscitated or not. A total of 91 (17.6%) post‐CPR donors had been accepted for transplantation (mean duration of cardiac arrest, 19.4 $\pm$ 15.6 min). Those donors were younger ($\it P$ < 0.001), had lower pancreas donor risk index (PDRI, $\it P$ = 0.003), and had higher serum creatinine levels ($\it P$ = 0.021). With a median follow‐up of 167 months (IQR 82–229), both groups demonstrated comparable short‐ and long‐term patient and graft survival. The resuscitation time (<20 min vs. ≥20 min) also showed no impact, with similar survival rates for both groups. A multivariable Cox regression analysis suggested no statistically significant association between donor CPR and patient or graft survival. Our results indicate that post‐CPR brain‐dead donors are suitable for PT without increasing the risk of complications