ANALYSIS OF EARLY READMISSIONS AFTER COMBINED PANCREAS-KIDNEY TRANSPLANTATION

Combined pancreas-kidney transplantation (PKT) has become generally ac cepted as an effective treatment option, but controversy exists regard ing the early morbidity rate of the procedure. To address this issue, we retrospectively analyzed all readmissions occurring in the first 3 months after PKT. Over a 5-year period, we performed 98 PKTs with blad der drainage. The mean recipient age was 36.6 years, with a mean pretr ansplant duration of diabetes of 23.5 years. All patients received qua druple immunosuppression with antilymphocyte induction therapy. The me an length of initial hospital stay was 20 days. One hundred forty-five readmissions occurred in 73 patients (74.5%), with the initial readmi ssion occurring at a mean of 8.5 days after hospital dismissal and 28 days after PKT. Twenty-five patients (25.5%) had no readmissions, 35 ( 36%) had one readmission, 17 (17%) had two readmissions, and the remai ning 21 patients (21.5%) had three or more readmissions in the first 3 months. The mean number of readmissions was 1.5 per patient. Forty-se ven patients (48%) were readmitted within 1 week, and all but one init ial readmission occurred within 1 month of hospital dismissal. Causes of readmission included rejection (51), infection (32), pancreas-speci fic morbidity (such as dehydration, hematuria, or pancreatitis; 50), a nd miscellaneous causes (12). Thirteen patients (13%) underwent reoper ation during readmission. The mean length of hospital stay during read mission was 7.6 days. The mean total length of hospitalization in the first 3 months after PKT was 31 days. Over the span of 5 years, no cha nges have occurred either in the incidence, timing, causes, or duratio n of readmissions. The patient survival rate is 96%, the kidney graft survival rate is 90%, and the pancreas graft survival rate is 88% afte r a mean follow-up of 2.6 years. Mean rehabilitation time (return to w ork or normal activity) after PKT was 4.0 months. In conclusion, PKT i s associated with a fixed morbidity characterized by early readmission (within 1 week) in nearly half of patients and pancreas-specific morb idity as the cause in 35% of readmissions. During evaluation, prospect ive candidates should be counseled regarding the unique morbidity of P KT. Successful management strategies must emphasize the intensity of e arly follow-up and recognize the propensity toward immunologic, metabo lic, exocrine, and urologic side effects. (C) 1996 by the National Kid ney Foundation, Inc.