Hauck, Roxanna D.1; Nijhoff, Michiel1; Pierik, Laurens H.2; van Rijswijk, Carla SP2; van Erkel, Arian R.2; van der Meer, Rutger W.2; de Koning, Eelco JP1; Burgmans, Mark C.2
1Internal Medicine, Leiden University Medical Centre, Leiden, Netherlands; 2Radiology, Leiden University Medical Centre, Netherlands
Background: Islet-after-kidney (IAK) transplantation is a minimally invasive procedure offered to patients with severe beta-cell deficiency who previously received a kidney graft. The presence of chronic kidney disease (CKD), that is often present in this population, and the use of anticoagulants or antiplatelet agents (AC/AP) increases the risk of bleeding. We assessed the rate of procedure-related complications in patients undergoing IAK transplantation.
Methods: In this retrospective, single-centre study we included patients who received at least one allogeneic IAK transplantation between 2007 and 2025 at the Leiden University Medical Centre. Complications were assessed according to the CTCAEv5.0 and stimulated C-peptide during a mixed meal test was measured after 3 months to evaluate islet graft function.
Results: Fifty-three patients (female 32.1%, age 52.8±9.4 years) received eighty-five IAK procedures. AC/AP were used prior to 48/85(56.5%) procedures. eGFR was similar before AC/AP and non-AC/AP procedures (57.7±21.8 mL/min (AC/AP) vs. 55.7±20.8 mL/min (non-AC/AP)), p=0.68). Bleeding occurred after 8/85 procedures (7/48(14.6%) AC/AP; 1/37(2.7%) non-AC/AP). Two grade 4 and two grade 3 bleeding episodes occurred. All bleeding episodes after AC/AP procedures occurred in patients using carbasalate calcium. There were no portal vein thromboses, biliary system punctures, or grade 5 complications. Pain was registered in 13/85 procedures and was treated with analgesics. Univariate logistic regression analysis (LRA) identified sex (OR 1.16, 95%CI [0.92-1.48], p=0.018), carbasalate calcium use (OR 9.844, 95%CI [1.15-83.98], p=0.037), and multiple punctures (OR 8.04, 95%CI [1.48-43.81], p=0.16) as potential factors associated with bleeding. In multivariate LRA only multiple punctures remained (OR 9.2, 95% CI[1.00-84.47], p=0.05). Bleeding did not affect max. stimulated C-peptide post-transplantation (0.17(IQR 0.08-0.28) nmol/L (non-bleeding) vs. 0.09(IQR 0.04-0.38) nmol/L (bleeding), p=0.147).
Conclusion: Multiple punctures but not AC/AP were associated with an increased risk of bleeding in IAK recipients. Portal thrombosis is not a serious risk in IAK transplantation.