Frontiers in immunology · 2026
Impact of donor stress-induced hyperglycemia on early graft outcomes in simultaneous pancreas-kidney transplantation: a retrospective cohort study.
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Liu Luhao, Chen Rongxin, Guo Yuhe, Guo Ziqing, Wan Jiao, Li Guanghui, Fang Jiali, Ma Junjie, Chen Zheng
Аннотация
BACKGROUND: The suitability of donors with stress-induced hyperglycemia (SIH) for pancreas-containing transplants remains debated due to concerns over β-cell dysfunction. This study aimed to assess whether donor SIH is associated with early clinical graft outcomes, including metabolic recovery, complications, and graft/patient survival, following simultaneous pancreas-kidney transplantation (SPKT).
METHODS: In this retrospective cohort study, 251 SPKT recipients were stratified into two groups based on donor glycemic status during ICU stay: Normoglycemia (NG, n=41; all glucose measurements ≤11.1 mmol/L without insulin therapy) and SIH (n=210; sustained glucose >11.1 mmol/L requiring intravenous insulin infusion). Recipient demographics, postoperative pancreatic/renal graft function, complications, and long-term survival were compared between groups.
RESULTS: Donor and recipient baseline characteristics were comparable between groups, except for higher admission glucose in the SIH cohort. Postoperatively, no significant differences were observed between the SIH and NG groups in serial measurements of fasting glucose, HbA1c, C-peptide, serum amylase, or serum creatinine at 7 days, 1, 6, and 12 months (all p>0.05). Complication rates, including delayed graft function, acute rejection, graft thrombosis, and surgical fistulas, were also similar (all p>0.05). Most importantly, Kaplan-Meier analysis revealed no significant differences in death-censored pancreas or kidney graft survival, or in overall patient survival over the follow-up period (maximum 9.2 years) (all log-rank p>0.05).
CONCLUSION: In this single-center, retrospective cohort with limited statistical power, we did not detect a statistically significant association between donor SIH and adverse early metabolic recovery, complication rates, or long-term graft and patient survival following SPKT. These observational data do not establish equivalence. The study is underpowered for uncommon events such as graft thrombosis, and clinically meaningful differences cannot be excluded. The findings should be interpreted as hypothesis-generating. They require prospective validation in larger, multi-center cohorts before informing clinical practice.
METHODS: In this retrospective cohort study, 251 SPKT recipients were stratified into two groups based on donor glycemic status during ICU stay: Normoglycemia (NG, n=41; all glucose measurements ≤11.1 mmol/L without insulin therapy) and SIH (n=210; sustained glucose >11.1 mmol/L requiring intravenous insulin infusion). Recipient demographics, postoperative pancreatic/renal graft function, complications, and long-term survival were compared between groups.
RESULTS: Donor and recipient baseline characteristics were comparable between groups, except for higher admission glucose in the SIH cohort. Postoperatively, no significant differences were observed between the SIH and NG groups in serial measurements of fasting glucose, HbA1c, C-peptide, serum amylase, or serum creatinine at 7 days, 1, 6, and 12 months (all p>0.05). Complication rates, including delayed graft function, acute rejection, graft thrombosis, and surgical fistulas, were also similar (all p>0.05). Most importantly, Kaplan-Meier analysis revealed no significant differences in death-censored pancreas or kidney graft survival, or in overall patient survival over the follow-up period (maximum 9.2 years) (all log-rank p>0.05).
CONCLUSION: In this single-center, retrospective cohort with limited statistical power, we did not detect a statistically significant association between donor SIH and adverse early metabolic recovery, complication rates, or long-term graft and patient survival following SPKT. These observational data do not establish equivalence. The study is underpowered for uncommon events such as graft thrombosis, and clinically meaningful differences cannot be excluded. The findings should be interpreted as hypothesis-generating. They require prospective validation in larger, multi-center cohorts before informing clinical practice.