Department of Anesthesiology and Intensive Care Medicine, Pavilion P, Edouard Herriot Hospital, Hospices Civils de Lyon, Claude Bernard University Lyon 1, Lyon, France.
Transplantation. 2012 Jul 27;94(2):159-64. doi: 10.1097/TP.0b013e318254dae1.
Simultaneous pancreas-kidney transplantation (SPKT) is a promising therapy for type 1 diabetes mellitus with chronic kidney disease. Although the long-term outcome of SPKT is extensively documented, the incidence of early complications within the first weeks after the surgery is less described. The aim of this study was to assess the incidence, causes, and risk factors of early relaparotomy after SPKT.
All SPKT performed in the university hospital between 2005 and 2008 were enrolled. The primary endpoint was defined as the need for at least one relaparotomy after SPKT within the initial hospital stay. The secondary endpoints were the incidence of vascular graft thrombosis, postoperative sepsis, patient, and graft survival.
Sixty-one patients were included. During their initial hospital stay, 27 (44.3%) SPKT recipients required at least one relaparotomy. The main causes of relaparotomy were hemorrhage (59.3%) and vascular graft thrombosis (22.2%). First relaparotomy occurred at a median postoperative time of 1 day (interquartile range, 1-6). Pretransplant dialysis and nontraumatic cause of donor brain death were identified as independent risk factors for early relaparotomy. Thirty-two patients (52.4%) experienced a symptomatic or asymptomatic vascular graft thrombosis.
The early postoperative period remains a high-risk phase for relaparotomy. The selection of recipients before initiation of long-term dialysis and of donors deceased from traumatic causes may reduce the rate of these early complications after SPKT. Vascular graft thrombosis and bleeding are two major issues that arise during this critical period, suggesting the importance an adequate management of postoperative anticoagulation and hemostasis.
胰肾联合移植（SPKT）是治疗 1 型糖尿病伴慢性肾脏病的一种有前途的疗法。尽管 SPKT 的长期结果已有广泛的记录，但术后最初几周内早期并发症的发生率描述较少。本研究旨在评估 SPKT 后早期再次剖腹手术的发生率、原因和危险因素。
纳入 2005 年至 2008 年在大学医院进行的所有 SPKT。主要终点定义为在初始住院期间至少需要进行一次 SPKT 再次剖腹手术。次要终点为血管移植物血栓形成、术后脓毒症、患者和移植物存活率。
共纳入 61 例患者。在初始住院期间，27 例（44.3%）SPKT 受者需要至少一次再次剖腹手术。再次剖腹手术的主要原因是出血（59.3%）和血管移植物血栓形成（22.2%）。首次再次剖腹手术发生在术后第 1 天（中位数，1-6 天）。移植前透析和供体脑死亡的非创伤性原因被确定为早期再次剖腹手术的独立危险因素。32 例患者（52.4%）出现症状性或无症状性血管移植物血栓形成。
术后早期仍然是再次剖腹手术的高风险阶段。在开始长期透析之前选择受者，并选择因创伤性原因导致供体死亡，可能会降低 SPKT 后这些早期并发症的发生率。血管移植物血栓形成和出血是这一关键时期出现的两个主要问题，提示术后抗凝和止血的管理非常重要。
