Per-operative changes and related factors during simultaneous pancreas-kidney transplantation: first experience at a Brazilian university hospital

Several factors influence ischemic/reperfusion injury in simultaneous pancreas-kidney transplantation (SPKT). Per-operative period is full of intense changes in systemic parameters related to pancreatic reperfusion (PR). This work aims to study these changes evaluating fluid reposition, need of vasopressors and other related factors.

Sixteen SPKT enduring patients mean age 32.4+/-4.76 had metabolic, electrolyte and hemodynamic data evaluated and compared at three times. Arterial blood gases, glucose, hematocrit; Na, K; MAP, HR and PAP were monitored after skin incision (T1), before and after PR (T2-T3). Fluid reposition, vasopressors, endocrine graft recovery and other related factors as donors, grafts, surgery team and receptors were also considered.

Glucose, PaO2, PaCO2 and electrolytes didn't vary along the times. From T1v.T2 there was significant metabolic acidosis; T2v.T3 identified tachycardia and pulmonary hypertension; T1v.T3 confirmed metabolic acidosis, hemodilution and arterial hypotension. Use of crystalloids (8500+/-2909.75 mL), colloids (647.05+/-492.59 mL), human albumin (8.57+/-2.44 U), fresh frozen plasma (1.06+/-1.91 U), platelets (1.86+/-4.16 U) and red packed cells (5.75+/-3.25 U), needs of noradrenalin and dobutamin: 37,5% and 6,25%. Endocrine graft recovery median was 4.15 h. Related factors to donor's: 25.43+/-8.14 years, BMI 23.24+/-1.66, serum creatinine 1.1+/-0.47mg/dl, hemodynamically stable and trauma as cause of 50% donors brain death; graft storage: cold ischemia time (CIT) median of 12.5 h; surgery team: warm ischemia time (WIT) median of 60min; receptors: ASA4, type 1 diabetes mellitus and end stage renal disease medias of 18.87+/-5.64 and 2+/-1.3 years.

Our experience confirmed the intense instability related in literature caused by PR in SPKT.