ITS 2012 Report – Novel aspects in SPK transplantation: Kidney allograft survival

by Maria Dalby – Patients undergoing simultaneous pancreas and kidney (SPK) transplantation where the drainage is led to the bladder are more likely to suffer acute rejection episodes and/or recurrent urinary tract infections (UTI) compared with patients undergoing SPK with enteric drainage. Bladder-drained SPK is also associated with reduced kidney graft survival, although pancreas survival and overall patient survival appear to be similar. Dr Rajinder Pal Singh, transplant surgeon at Guy’s & St Thomas’ Hospital in London, reported on a retrospective study over a 15-year period during which the centre switched from bladder drainage to enteric drainage.

A total of 223 patients underwent SPK at Guy’s & St Thomas’ Hospital between August 1996 and October 2011. Patients transplanted before July 2006 (94 patients, 42%) had bladder drainage; from this point onwards enteric drainage was used (129 patients). Kidney graft survival was significantly reduced in the bladder-drainage group compared with enteric drainage at one year (91% vs 96%; p<0.05) and five years (83% vs 95%; p<0.05) post-transplant. The five-year pancreas graft survival rate was similar in the two groups at 81% and 82%, respectively, as was the overall patient survival rate (90% and 97%, respectively). The bladder-drainage group had fewer cases of delayed graft function and viral and wound infections, but more biopsy-proven acute rejections and recurrent UTIs. Multivariate analysis showed that bladder drainage was a significant risk factor for kidney graft loss after SPK transplantation; Dr Singh speculated that the underlying cause for this may connected with UTIs and other complications that cause release of pancreatic exocrine enzymes into the bladder.

Rajinder Pal Singh, Guy’s & St Thomas’ Hospital, London, UK