Peri-transplant glycaemic control as a predictor of pancreas transplant survival.

AIMS: The relationship between peri-transplant glycaemic control and outcomes following pancreas transplantation is unknown. We aimed to relate peri-transplant glycaemic control to pancreas graft survival and to develop a framework for defining early graft dysfunction. METHODS: Peri-transplant glycaemic control profiles over the first 5 days postoperatively were determined by an area under the curve [AUC; average daily glucose level (mmol/L) × time (days)] and the coefficient of variation of mean daily glucose levels. Peri-transplant hyperglycaemia was defined as an AUC ≥35 mmol/day/L (daily mean blood glucose ≥7 mmol/L). Risks of graft failure associated with glycaemic control and variability and peri-transplant hyperglycaemia were determined using covariate-adjusted Cox regression. RESULTS: We collected 7606 glucose readings over 5 days postoperatively from 123 pancreas transplant recipients. Glucose AUC was a significant predictor of graft failure during 3.6 years of follow-up (unadjusted HR [95% confidence interval] 1.17 [1.06-1.30], P = .002). Death censored non-technical graft failure occurred in eight (10%) recipients with peri-transplant normoglycaemia, and eight (25%) recipients with peri-transplant hyperglycaemia such that hyperglycaemia predicted a 3-fold higher risk of graft failure [HR (95% confidence interval): 3.0 (1.1-8.0); P = .028]. CONCLUSION: Peri-transplant hyperglycaemia is strongly associated with graft loss and could be a valuable tool guiding individualized graft monitoring and treatment. The 5-day peri-transplant glucose AUC provides a robust and responsive framework for comparing graft function.

Alternative surgical procedure for treating superior vena cava syndrome in a hemodialysis patient.

BACKGROUND: The incidence of superior vena cava syndrome has been increasing in hemodialysis patients with the widespread use of dialysis catheters. Although endovascular intervention remains the primary choice for treatment, the long-term patency rate is not optimistic. Occlusive lesions are often encountered that cannot be opened using this intervention. Therefore, we chose to present this case involving a pericardial patch used to reconstruct the superior vena cava in the treatment of catheter-associated chronic superior vena cava occlusion. METHODS: Here, we report a case of facial swelling and severe bilateral pleural effusion secondary to superior vena cava occlusion in a 41-year-old woman. An endovascular venous intervention was attempted initially but failed. Finally, we adopted a procedure using the pericardium as a patch to reconstruct the superior vena cava, maintaining most of the original anatomical structure. RESULTS: This patient's facial swelling and bilateral pleural effusion disappeared after the operation. In addition, her symptoms of coughing and dyspnea were relieved. The Brescia-Cimino fistula in her left forearm functioned well. CONCLUSION: The use of a pericardial patch to reconstruct the superior vena cava is a reliable approach in patients who are not candidates for endovascular treatment.