Effect of Anticoagulation and Individualized Fluid Therapy on Graft Outcomes in Simultaneous Pancreas-Kidney Transplant Recipients

Background Simultaneous pancreas-kidney (SPK) transplantation is the preferred treatment for type 1 diabetes mellitus with end-stage renal disease. Early graft loss, especially from pancreatic thrombosis, remains a major challenge. Optimal anticoagulation and fluid strategies are critical but not standardized. Methodology We retrospectively reviewed 64 SPK transplants in our center. Group 1 (n = 28) received liberal fluid infusion guided by urine output (>200 mL/hour) and prophylactic low-molecular-weight heparin. Group 2 (n = 36) received unfractionated heparin (UFH) infusion titrated to an activated partial thromboplastin time ratio of 1.5 and PiCCO®-guided fluid management, as a new postoperative protocol was implemented. Patient and graft characteristics and outcomes were analyzed. Results Donor and recipient baseline characteristics were comparable. We found a meaningful reduction in pancreas graft thrombosis in Group 2 (6% vs. 18%, p = 0.167), along with similar hemorrhagic complications (21% vs 28%, p = 0.187). Group 2 had higher cumulative fluid balance at 72 hours (9,704 vs. 7,436 mL, p = 0.027) and improved P/F ratio on day 3 (304 vs. 296, p = 0.033). We also documented a reduction in renal delayed graft function (11% vs. 3%, p = 0.171). A relevant increase in pancreas graft survival was seen (71% vs. 92%, p = 0.641), but renal graft survival was similar. Hospital and intensive care unit mortality was similar between the two groups. Conclusions UFH anticoagulation combined with PiCCO®-guided fluid management may reduce pancreas thrombosis and delayed renal graft function, without significantly increasing bleeding risk. A patient-specific perioperative approach could enhance SPK transplant outcomes.