Babatunde Campbell

Outcome of pancreas transplantation in recipients older than 50 years: a single-centre experience.

Background. Pancreas transplantation (PT) remains the only treatment that can restore insulin independence among insulin-dependent diabetics. An ageing population in developed countries has led to an increasing number of older patients who may be suitable for PT. Some investigators argue that PT in recipients older than 50 years has an inferior outcome compared with the younger group. Methods. The object of this study was to compare the outcomes of 31 PT in patients aged 50 and above 105 PT in recipients below 50 years performed between June 2001 and December 2007. Results. The incidence of general posttransplant complications were similar in both; 60% in less than 50 vs. 58% in more than or equal to 50, P=0.539. So, as the incidence of other surgical complication in the more than or equal to 50 group compared with less than 50 (graft thrombosis 13% vs. 11.5%; bleeding 19% vs. 6.7%; abdominal abscess 23% vs. 19%; pancreatic leak 13% vs. 9.6%). There was no significant difference in the incidence of urinary tract infection and early rejection in either group. However, the incidence of respiratory tract infection was significantly higher in more than or equal to 50 (38.7% in ≥50 vs. 9.6% in <50, P=0.003). One-year patient survival was 88% in more than or equal to 50 vs. 92% in less than 50 group, P=0.399; and pancreas graft survival rate was similar (79% in the ≥50 and 74% in <50, P=0.399). Conclusion. This study demonstrates that it is feasible to safely transplant potentional PT recipients aged 50 and above. However, good medical assessment and careful patient selection is strongly recommended.

Mortality in diabetes: pancreas transplantation is associated with significant survival benefit

BACKGROUND Pancreas transplantation in complicated type 1 (insulin dependent) diabetes mellitus improves the quality of life, increases longevity and stabilizes diabetic complications. There may be clinician reticence due to perceived poor outcomes with published associated mortality rates of 5-8% due to significant co-morbidities, particularly cardiovascular impairment. METHODS Retrospective analysis was performed on patients undergoing pancreas transplantation in a single centre since the programmes initiation [simultaneous pancreas kidney (SPK) = 148, pancreas after kidney (PAK) = 33 and pancreas transplant alone (PTA) = 11] compared with a control group accepted contemporaneously onto the waiting list. The primary endpoint was patient mortality. The risk factors including medical and diabetic history, demographics, transplant type and waiting time were analysed. RESULTS The waiting list mortality was 30% (35 of 120) compared with a mortality of 9% (20 of 193) post-transplantation (P < 0.001). Deaths on the waiting list compared with transplantation up to 1 year had a relative risk of 2.67 (95% CI: 0.81-3.51; P = 0.19), whilst those surviving >1 year had a relative risk of 5.89 of dying on the waiting list (95% CI: 1.70-3.20; P < 0.0005). There were no differences in terms of cardiovascular or renal-associated risk factors, nor in other potential confounding factors other than duration of diabetes (P = 0.02). Median survival from listing was shorter in younger patients (<50; P < 0.0001). CONCLUSIONS Type 1 diabetics with renal failure listed for pancreas transplantation are at a significant risk of mortality even without surgery. Transplantation offers considerable survival benefits, despite associated surgical and immunosuppressive risks. In selected patients, pancreas transplantation remains the benchmark treatment for type 1 diabetes mellitus.

Native nephrectomy for autosomal dominant polycystic kidney disease: before or after kidney transplantation?

Study Type – Therapy (case series)

Letter to the editor: giant angiomyxoid tumor in a renal allograft

Tumors occurring de novo in renal allografts are rare [1]. We report a case of a giant tumor in a failed transplanted kidney presenting as an abdominal mass 12 years after transplantation. A 44-year-old man with primary renal disease of glomerulonephritis as a child underwent renal transplant from a 32-year-old deceased brain-dead donor in 1996. The mismatch was 1:1:0; primary immunosuppresssion used were Neoral and prednisolone. The patient experienced two steroid-responsive rejection episodes with complete recovery of serum creatinine. The renal transplant failed in 2004. Histology report prior to graft failure showed chronic allograft nephropathy. Neoral was ceased 3 months after the transplanted kidney failure, and hemodialysis was recommenced in November 2005. The patient was asymptomatic until he was first noted to have a protruding abdomen at a consultation in August 2007; as he denied any symptoms, he declined intervention after this consultation. Increased abdominal girth was noted at another clinic visit in February 2008 with an obvious distended tender mass arising in the left iliac fossa, which extended across the midline and to the right. The mass was arising from the pelvis and reached the supra-umbilical region, at the site of the transplanted kidney. The patient, at this time, agreed to undergo a CT scan. CT of the abdomen and pelvis with contrast from June 2008 showed the mass measuring 14 · 18 · 21 cm (Fig. 1a). It appeared to be arising from the transplant kidney, encasing the iliac vessels. Given the size and its welldefined margins, it was thought to be benign. The patient consented for surgical excision of the mass in August 2008 because of increasing pressure symptoms. A preoperative angiogram illustrated vascular supply of the pelvic mass originating from the transplant renal artery. Preoperative embolization of this artery was carried out to minimize blood loss during surgery. A midline incision revealed a large tumor arising from the left transplanted kidney (Fig. 1b). The mass was adherent to the transverse colon, bladder and left body wall, surrounding iliac vessels and the urinary bladder. The mass was excised completely in two stages and the patient made an uneventful postoperative recovery. Subsequent histology examination showed a large nodular mass measuring 26 · 24 · 13 cm and weighing approximately 2 kg. Segments showed nodular myxoid and fatty tissue, completely replacing and extending beyond the failed transplant kidney, with no areas of frank necrosis. Microscopic examination reported a fibrous, myxoid and vascular lesion with spindle cells, and scattered infiltrate of inflammatory cells. The lesion partly involved the kidney with surrounding renal tubules in some areas. Most of the specimen was replaced by spindle cell formation; scanty nuclear pleomorphism was seen, but no necrosis was observed (Fig. 1c). As a result of the unusual histological appearance, it was reviewed by histolopathologists from three different