World journal of transplantation · 2026
Perioperative outcomes and phase-specific intraoperative glycemic management in simultaneous pancreas-kidney transplantation: A single-center case series.
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Montes Felix R, Gutierrez-Navarro Juan Diego, Restrepo-Patiño Natalia, Gutiérrez-Soriano Laura, Becerra-Zapata Eduardo, Kling Juan Carlos, Peña-Blanco Laura, Martinez-Ardila Rodrigo, Diaz-Riaño Nicolas, Gonzalez-Vasquez Laura, Ramirez-Sanchez Nathaly, Barrera-Lozano Luis Manuel
Аннотация
BACKGROUND: Simultaneous pancreas-kidney transplantation (SPKT), an established treatment for patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and end-stage renal disease (ESRD), provides metabolic stabilization and improved survival. Although perioperative glycemic control is crucial for graft viability; intraoperative management remains understudied, and standardized phase-specific protocols are lacking.
AIM: To explore the feasibility, safety, and immediate outcomes of a six-phase intraoperative glycemic control algorithm for SPKT.
METHODS: This retrospective case series included 11 patients with T1DM or T2DM and ESRD who underwent SPKT at a quaternary care center between January 2024 and May 2025. All patients were managed using a six-phase institutional glycemic control algorithm that maintains intraoperative blood glucose levels within predefined targets. Data on clinical, metabolic, surgical variables; complications; and early outcomes were collected.
RESULTS: In most cases, intraoperative blood glucose levels were maintained within target ranges; however variations were observed [range: 63-453 mg/dL (3.5-25.2 mmol/L)]. No severe hypoglycemia or ketoacidosis occurred. During the first 24 postoperative hours, seven patients (63.6%) achieved euglycemia without exogenous insulin, whereas two required transient insulin therapy. Six patients (54.5%) had postoperative complications, including thrombotic (n = 4), infectious (n = 2), and reperfusion syndrome (n = 1). One patient experienced more than one event. All events were successfully managed, without graft loss, acute rejection, or in-hospital mortality.
CONCLUSION: The phase-specific intraoperative glycemic protocol for SPKT is feasible and safe. However, prospective studies with larger cohorts are warranted to assess its long-term impact on graft survival and patient outcomes.
AIM: To explore the feasibility, safety, and immediate outcomes of a six-phase intraoperative glycemic control algorithm for SPKT.
METHODS: This retrospective case series included 11 patients with T1DM or T2DM and ESRD who underwent SPKT at a quaternary care center between January 2024 and May 2025. All patients were managed using a six-phase institutional glycemic control algorithm that maintains intraoperative blood glucose levels within predefined targets. Data on clinical, metabolic, surgical variables; complications; and early outcomes were collected.
RESULTS: In most cases, intraoperative blood glucose levels were maintained within target ranges; however variations were observed [range: 63-453 mg/dL (3.5-25.2 mmol/L)]. No severe hypoglycemia or ketoacidosis occurred. During the first 24 postoperative hours, seven patients (63.6%) achieved euglycemia without exogenous insulin, whereas two required transient insulin therapy. Six patients (54.5%) had postoperative complications, including thrombotic (n = 4), infectious (n = 2), and reperfusion syndrome (n = 1). One patient experienced more than one event. All events were successfully managed, without graft loss, acute rejection, or in-hospital mortality.
CONCLUSION: The phase-specific intraoperative glycemic protocol for SPKT is feasible and safe. However, prospective studies with larger cohorts are warranted to assess its long-term impact on graft survival and patient outcomes.