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The superior death‐censored graft survival of the pancreas allograft in simultaneous pancreas kidney transplants (SPK) over pancreas alone transplants (PTA) has long been recognized. Using data from the Scientific Registry of Transplant Recipients (SRTR) and a high‐volume pancreas transplant program, we investigated the possible protective role of the kidney allograft in SPK transplants. We analyzed 19 043 primary pancreas transplants between 2000 and 2020, including 735 transplants performed at the University of Minnesota. SPK transplants demonstrated a superior death‐censored graft survival over pancreas after kidney (PAK) and simultaneous pancreas and living donor kidney (SPLK) transplants, which both demonstrated better survival than PTA transplants. This effect was not affected by mode or duration of renal replacement therapy prior to transplant. Furthermore, we found that HLA match at the B‐locus between the prior kidney and current pancreas allografts demonstrated a protective effect (HR.54; 95% confidence interval.29–1.00), with a 2‐antigen match demonstrating superior death‐censored graft survival to a 1‐ or 0‐antigen match. We propose that a homologous kidney allograft in SPK transplants affords protection to the pancreas allograft–likely through a combination of better surveillance for rejection and direct immunoprotection offered by the same‐donor kidney. [ABSTRACT FROM AUTHOR]

Postoperative pain is a significant source of morbidity in patients undergoing living donor nephrectomy (LDN) and a deterrent for candidates. We implemented a standardized multimodal analgesic regimen, which consists of pharmacist‐led pre‐procedure pain management education, a combination transversus abdominis plane and rectus sheath block performed by the regional anesthesia team, scheduled acetaminophen and gabapentin, and as‐needed opioids. This single‐center retrospective study evaluated outcomes between patients undergoing LDN who received a multimodal analgesic regimen and a historical cohort. The multimodal cohort had a significantly shorter length of stay (LOS) (days, mean ± SD: 1.8 ± 0.7 vs. 2.6 ± 0.8; p <.001) and a greater proportion who were discharged on postoperative day (POD) 1 (38.6% vs. 1.5%; p <.001). The total morphine milligram equivalents (MME) that patients received during hospitalization were significantly less in the multimodal cohort on POD 0‐2. The outpatient MME prescribed through POD 60 was also significantly less in the multimodal cohort (median [IQR]; 180 [150‐188] vs. 225 [150‐300]; p <.001). The mean patient‐reported pain score (PRPS) was significantly lower in the multimodal cohort on POD 0‐2. The maximum PRPS was significantly lower on POD 0 (mean ± SD: 7 ± 2 vs. 8 ± 1, respectively; p =.02). This study suggests that our multimodal regimen significantly reduces LOS, PRPS, and opioid requirements and has the potential to improve the donation experience. [ABSTRACT FROM AUTHOR]

Abstract: With increasing organ demand, living kidney donation from older donors (>60‐years‐old) has become more common. Between 1975 and 2014, 3752 donor nephrectomies (DN) were performed at University of Minnesota; 167 (4.5%) were >60‐years‐old Short‐ and long‐term outcomes were compared between contemporaneous >60‐years‐old and <60‐years‐old donors. On univariate analysis, >60‐years‐old were more likely to have had prior abdominal surgery and hypertension; and less likely to smoke. Baseline estimated glomerular filtration rate (eGFR) was lower in >60‐years‐old (80 ± 16 vs 101 ± 26 mL/min/1.73 m2; P < .001). Intraoperative and postoperative complications were similar, except a higher prevalence of <30 day ileus (3% vs 7%; P = .021) and longer postoperative length of stay (LOS) (4.2 vs 4.6 days; P = .005). On multivariate analysis, <30 day ileus and LOS continued to be significantly greater for >60‐years‐old After >20 years post‐DN, systolic blood pressure was significantly higher among >60‐years‐old (142 vs 125 mm Hg; P < .001) and HTN was diagnosed earlier (9 vs 14 years). After donation, eGFR was significantly lower for >60‐years‐old but slope of eGFR and rates of end‐stage renal disease (ESRD) were not significantly different >20 years post‐DN. Thus, kidney donation among carefully selected >60‐years‐old poses minimal perioperative risks and no added risk of long‐term ESRD. [ABSTRACT FROM AUTHOR]

The first successful kidney transplant occurred in 1954. Since then, long-term graft survival has been an elusive idealistic goal of transplantation. Yet 62 years later, we know of only 6 kidney transplant recipients who have achieved ≥ 50-year graft survival while being on no immunosuppression or a substantially reduced regimen. Herein, we report graft survival ≥ 50 years in 2 living donor recipients who have been maintained on standard-of-care immunosuppression the entire time. For our 2 recipients, their living donor's altruism altered the course, length, and quality of their life, which by all accounts can be deemed normal: They attended college, held jobs, had successful pregnancies, raised families, and were productive members of society. Both donors are still alive and well, more than 50 years post-donation; both have an acceptable GFR and normal blood pressure, with hyperlipidemia as their only medical problem. These 2 intertwined stories illustrate the tremendous potential of a successful kidney transplant: long-term survival with a normal lifestyle and excellent quality of life, even after more than 5 decades on full-dose immunosuppression. [ABSTRACT FROM AUTHOR]

Kidney transplantation entails well‐coordinated complex care delivery. Patient‐provider cultural and linguistic discordance can lead to healthcare disparities. We analyzed kidney transplantation outcomes among our institution's Hmong recipients using a retrospective cohort study. From 1995 to 2015, 2164 adult (age ≥18) recipients underwent kidney transplantation at our institution; 78 self‐identified as Hmong. Survival rates were analyzed and compared to Caucasian recipients (n = 2086). Fifty (64.1%) Hmong recipients consistently requested interpreters. Mean follow‐up was 9.8 years for both groups. Hmong recipients (N = 78) were on average younger at transplant (45.7 vs 49.7 years; P = 0.02), more likely to be female (56% vs 38%; P = 0.001), and had higher gravidity (5.0 vs 1.9 births; P < 0.001). There were 13 (16.7%) Hmong living donor recipients, who were younger (32.8 vs 42.9 years; P = 0.006) at transplant compared to Caucasians (1429, 68.5%). Hmong 1‐ and 5‐year patient survival was 100%; Caucasians, 97.1% and 88% (P < 0.001). Hmong 1‐ and 5‐year graft survival was 98.7% and 84.9%; Caucasians 94.8% and 80.9% (P = 0.013). One‐ and 5‐year rejection‐free survival showed no difference (88.9% vs 82.4%; 86.7% vs 83.4%, P = 0.996). Despite cultural and linguistic differences between Hmong recipients and providers, we found no evidence of inferiority in KT outcomes in the Hmong population. [ABSTRACT FROM AUTHOR]