Treatment and management of complications of hyperkalemia after simultaneous pancreas and kidney transplantation_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HU Yitao ¹ , XU Liangliang ¹ , SONG Turun ¹ ,  LIN Tao ¹ , ZHANG Ming ¹ ,  XU Mingqing ¹ , LI Shifeng ²

1. Organ Transplantation Center & Department of Liver Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. Oklahoma Transplant Center, OU Medical Center, Oklahoma City, OK 73104, U.S.A.;

Corresponding author：

LIN Tao, Email: kidney5@163.com; XU Mingqing, Email: xumingqing@scu.edu.cn

Keywords：

simultaneous pancreas and kidney transplantation; diabetes; end-stage renal disease; postoperative hyperkalemia

DOI：

10.7507/1007-9424.202101040

Video：

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Objective To summarize the perioperative management experience and the treatment strategy of hyperkalemia after simultaneous pancreas and kidney transplantation (SPK).Method The clinical data of patients with diabetes combined with end-stage renal disease who accepted SPK in the Organ Transplantation Center of West China Hospital of Sichuan University from November 2017 to November 2019 were retrospectively analyzed.Results A total of 6 patients accepted SPK totally. The cold ischemia time of all allografts was less than 8 h. The levels of fasting blood glucose and serum creatinine were normal in the 5 surviving patients, and the diabetic complications were relieved or improved, except for 1 patient who died of cardiac arrest due to acute left heart failure. There were 1 case of delayed primary renal function recovery, 2 cases of bleeding in the surgical area of pancreas transplantation, 1 case of gastrointestinal bleeding, 3 cases of microthrombosis in the blood vessels of pancreas transplantation, 2 cases of perirenal effusion infection, 2 cases of pulmonary infection, and 1 case of ureterobladder anastomotic leakage, all of which were cured after symptomatic treatment. Only 2 patients occurred hyperkalemia after SPK (the highest level was 6.49 mmol/L and 6.67 mmol/L respectively), and transfusion of 10% glucose injection contain insulin, emergency dialysis and oral fludrocortisone were successively performed on them to restore the potassium density in 1 month and 2 months after surgery. There were no complications of perioperative surgical technical hemorrhage, intestinal leakage, large arteriovenous thrombosis, necrotizing pancreatitis, etc.Conclusions SPK is the most effective treatment for patients with diabetes combined with end-stage renal disease. Transfusion of 10% glucose injection contain insulin, emergency dialysis, and oral fludrocortisone are effective strategies in treating hyperkalemia after SPK.

Citation： HU Yitao, XU Liangliang, SONG Turun, LIN Tao, ZHANG Ming, XU Mingqing, LI Shifeng. Treatment and management of complications of hyperkalemia after simultaneous pancreas and kidney transplantation. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(4): 421-425. doi: 10.7507/1007-9424.202101040 Copy

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2.	Papatheodorou K, Papanas N, Banach M, et al. Complications of diabetes 2016. J Diabetes Res, 2016, 2016: 6989453.
3.	White SA, Shaw JA, Sutherland DE. Pancreas transplantation. Lancet, 2009, 373(9677): 1808-1817.
4.	Yadav K, Young S, Finger EB, et al. Significant arterial complications after pancreas transplantation—A single-center experience and review of literature. Clin Transplant, 2017, 31(10): e13070.
5.	Kaplan B, Wang Z, Abecassis MM, et al. Frequency of hyperkalemia in recipients of simultaneous pancreas and kidney transplants with bladder drainage. Transplantation, 1996, 62(8): 1174-1175.
6.	Montford JR, Linas S. How dangerous is hyperkalemia? J Am Soc Nephrol, 2017, 28(11): 3155-3165.
7.	任生生, 许亮亮, 宋涂润, 等. 胰肾联合移植治疗糖尿病肾功能衰竭五例临床分析. 中华器官移植杂志, 2019, 40(5): 272-276.
8.	Grochowiecki T, Gałązka Z, Madej K, et al. Early complications related to the transplanted kidney after simultaneous pancreas and kidney transplantation. Transplant Proc, 2014, 46(8): 2815-2817.
9.	Khubutia MS, Pinchuk AV, Dmitriev IV, et al. Surgical complications after simultaneous pancreas-kidney transplantation: A single-center experience. Asian J Surg, 2016, 39(4): 232-237.
10.	Dholakia S, Oskrochi Y, Easton G, et al. Advances in pancreas transplantation. J R Soc Med, 2016, 109(4): 141-146.
11.	Orsenigo E, Fiorina P, Dell ’Antonio G, et al. Gastrointestinal bleeding from enterically drained transplanted pancreas. Transpl Int, 2005, 18(3): 296-302.
12.	Palmer BF, Clegg DJ. Physiology and pathophysiology of potassium homeostasis. Adv Physiol Educ, 2016, 40(4): 480-490.
13.	Rangel EB. The metabolic and toxicological considerations for immunosuppressive drugs used during pancreas transplantation. Expert Opin Drug Metab Toxicol, 2012, 8(12): 1531-1548.
14.	Naesens M, Kuypers DR, Sarwal M. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol, 2009, 4(2): 481-508.
15.	Hoorn EJ, Walsh SB, McCormick JA, et al. Pathogenesis of calcineurin inhibitor-induced hypertension. J Nephrol, 2012, 25(3): 269-275.
16.	Terker AS, Zhang C, McCormick JA, et al. Potassium modulates electrolyte balance and blood pressure through effects on distal cell voltage and chloride. Cell Metab, 2015, 21(1): 39-50.
17.	Kovesdy CP. Management of hyperkalemia: An update for the internist. Am J Med, 2015, 128(12): 1281-1287.
18.	Velázquez H, Perazella MA, Wright FS, et al. Renal mechanism of trimethoprim-induced hyperkalemia. Ann Intern Med, 1993, 119(4): 296-301.
19.	Mohan S, Jaitly M, Pogue VA, et al. Influence of concomitant prednisolone on trimethoprim-associated hyperkalaemia. J Antimicrob Chemother, 2009, 64(4): 850-852.
20.	Tainio J. Calcineurin inhibitor-associated electrolyte disturbances after pediatric renal transplantation: Could fludrocortisone therapy have a role? Pediatr Transplant, 2018, 22(2): e13097.
21.	Jadoul M, Ferrant A, De Plaen JF, et al. Mineralocorticoids in the management of primary adrenocortical insufficiency. J Endocrinol Invest, 1991, 14(2): 87-91.
22.	Amador CA, Bertocchio JP, Andre-Gregoire G, et al. Deletion of mineralocorticoid receptors in smooth muscle cells blunts renal vascular resistance following acute cyclosporine administration. Kidney Int, 2016, 89(2): 354-362.
23.	Ali SR, Shaheen I, Young D, et al. Fludrocortisone—a treatment for tubulopathy post-paediatric renal transplantation: A national paediatric nephrology unit experience. Pediatr Transplant, 2018, 22(2): e13134.

1. Global report on diabetes, 2016. World Health Organization (2016). http://www.who.int/diabetes/global-report/en/.
2. Papatheodorou K, Papanas N, Banach M, et al. Complications of diabetes 2016. J Diabetes Res, 2016, 2016: 6989453.
3. White SA, Shaw JA, Sutherland DE. Pancreas transplantation. Lancet, 2009, 373(9677): 1808-1817.
4. Yadav K, Young S, Finger EB, et al. Significant arterial complications after pancreas transplantation—A single-center experience and review of literature. Clin Transplant, 2017, 31(10): e13070.
5. Kaplan B, Wang Z, Abecassis MM, et al. Frequency of hyperkalemia in recipients of simultaneous pancreas and kidney transplants with bladder drainage. Transplantation, 1996, 62(8): 1174-1175.
6. Montford JR, Linas S. How dangerous is hyperkalemia? J Am Soc Nephrol, 2017, 28(11): 3155-3165.
7. 任生生, 许亮亮, 宋涂润, 等. 胰肾联合移植治疗糖尿病肾功能衰竭五例临床分析. 中华器官移植杂志, 2019, 40(5): 272-276.
8. Grochowiecki T, Gałązka Z, Madej K, et al. Early complications related to the transplanted kidney after simultaneous pancreas and kidney transplantation. Transplant Proc, 2014, 46(8): 2815-2817.
9. Khubutia MS, Pinchuk AV, Dmitriev IV, et al. Surgical complications after simultaneous pancreas-kidney transplantation: A single-center experience. Asian J Surg, 2016, 39(4): 232-237.
10. Dholakia S, Oskrochi Y, Easton G, et al. Advances in pancreas transplantation. J R Soc Med, 2016, 109(4): 141-146.
11. Orsenigo E, Fiorina P, Dell ’Antonio G, et al. Gastrointestinal bleeding from enterically drained transplanted pancreas. Transpl Int, 2005, 18(3): 296-302.
12. Palmer BF, Clegg DJ. Physiology and pathophysiology of potassium homeostasis. Adv Physiol Educ, 2016, 40(4): 480-490.
13. Rangel EB. The metabolic and toxicological considerations for immunosuppressive drugs used during pancreas transplantation. Expert Opin Drug Metab Toxicol, 2012, 8(12): 1531-1548.
14. Naesens M, Kuypers DR, Sarwal M. Calcineurin inhibitor nephrotoxicity. Clin J Am Soc Nephrol, 2009, 4(2): 481-508.
15. Hoorn EJ, Walsh SB, McCormick JA, et al. Pathogenesis of calcineurin inhibitor-induced hypertension. J Nephrol, 2012, 25(3): 269-275.
16. Terker AS, Zhang C, McCormick JA, et al. Potassium modulates electrolyte balance and blood pressure through effects on distal cell voltage and chloride. Cell Metab, 2015, 21(1): 39-50.
17. Kovesdy CP. Management of hyperkalemia: An update for the internist. Am J Med, 2015, 128(12): 1281-1287.
18. Velázquez H, Perazella MA, Wright FS, et al. Renal mechanism of trimethoprim-induced hyperkalemia. Ann Intern Med, 1993, 119(4): 296-301.
19. Mohan S, Jaitly M, Pogue VA, et al. Influence of concomitant prednisolone on trimethoprim-associated hyperkalaemia. J Antimicrob Chemother, 2009, 64(4): 850-852.
20. Tainio J. Calcineurin inhibitor-associated electrolyte disturbances after pediatric renal transplantation: Could fludrocortisone therapy have a role? Pediatr Transplant, 2018, 22(2): e13097.
21. Jadoul M, Ferrant A, De Plaen JF, et al. Mineralocorticoids in the management of primary adrenocortical insufficiency. J Endocrinol Invest, 1991, 14(2): 87-91.
22. Amador CA, Bertocchio JP, Andre-Gregoire G, et al. Deletion of mineralocorticoid receptors in smooth muscle cells blunts renal vascular resistance following acute cyclosporine administration. Kidney Int, 2016, 89(2): 354-362.
23. Ali SR, Shaheen I, Young D, et al. Fludrocortisone—a treatment for tubulopathy post-paediatric renal transplantation: A national paediatric nephrology unit experience. Pediatr Transplant, 2018, 22(2): e13134.

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Treatment and management of complications of hyperkalemia after simultaneous pancreas and kidney transplantation

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