Diagnostic significance of intraoperative glycemic monitoring in assessing pancreatic graft function after simultaneous pancreas and kidney transplantation

Background. Intraoperative glycemic monitoring is important element for successful simultaneous pancreas and kidney transplantation (SPKT). It is necessary to achieve effective glycemic profile and reduce the incidence of early postoperative infectious complications. Correction of dysglycemia after pancreas graft reperfusion (PGR) is crucial for graft survival. Objective. To determine diagnostic and prognostic significance of intraoperative glycemic monitoring in assessing early pancreatic graft function. Material and methods. A retrospective analysis of glycemic monitoring data was performed in 85 recipients after SPKT. There were 52 (61%) men and 33 (39%) women, median age was 35 [31; 39] years. Glycemic data were analyzed at the main stages of surgery. Recipients were divided into two groups: group I — glycemia 5.0—10.0 mmol/L, group II — glycemia outside this range. Surgical and infectious complications, primary function of pancreatic graft, hospital-stay and graft survival were analyzed. Results. PGR is accompanied by significant decrease of intraoperative glycemia (p<0.001). Occlusive arterial thrombosis was more common in the 2nd group (by 19.6%, p=0.008). Intestinal anastomosis failure was more common in the same group (by 24.8%, p=0.005). Infectious complications were more common by 27.7% (p=0.007). Length of hospital-stay was 34.5 [25; 48] and 63 [33;84] days (p=0.022), in-hospital graft survival rate — 92.4% and 36.8%, respectively (p<0.001). Conclusion. Intraoperative glycemic monitoring revealed significantly lower glycemia after PGR and by the end of surgery compared to baseline values. Glycemic values 5—10 mmol/l at the end of surgery contribute to significantly lower rates of surgical and infectious complications, shorter hospital-stay, higher pancreatic graft survival and better outcomes after SPKT.