Perioperative outcomes and phase-specific intraoperative glycemic management in simultaneous pancreas-kidney transplantation: A single-center case series

doi:10.5500/wjt.v16.i2.115136

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World Journal of Transplantation

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2220-3230

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Transplant. Jun 18, 2026; 16(2): 115136
Published online Jun 18, 2026. doi: 10.5500/wjt.v16.i2.115136

Perioperative outcomes and phase-specific intraoperative glycemic management in simultaneous pancreas-kidney transplantation: A single-center case series

Felix R Montes, Juan Diego Gutierrez-Navarro, Natalia Restrepo-Patiño, Laura Gutiérrez-Soriano, Eduardo Becerra-Zapata, Juan Carlos Kling, Laura Peña-Blanco, Rodrigo Martinez-Ardila, Nicolas Diaz-Riaño, Laura Gonzalez-Vasquez, Nathaly Ramirez-Sanchez, Luis Manuel Barrera-Lozano

Felix R Montes, Laura Gutiérrez-Soriano, Juan Carlos Kling, Department of Anesthesiology, Fundación Cardioinfantil-Instituto de Cardiología, Bogota 111321, Colombia

Juan Diego Gutierrez-Navarro, Natalia Restrepo-Patiño, Eduardo Becerra-Zapata, Laura Peña-Blanco, Anesthesiology Research Group, Fundación Cardioinfantil-Instituto de Cardiologia, Bogota 111321, Colombia

Juan Diego Gutierrez-Navarro, Natalia Restrepo-Patiño, Rodrigo Martinez-Ardila, Nicolas Diaz-Riaño, Laura Gonzalez-Vasquez, Escuela de Medicina y Ciencias de la Salud, Colegio Mayor Nuestra Señora del Rosario, Bogota 110911, Colombia

Nathaly Ramirez-Sanchez, Luis Manuel Barrera-Lozano, Department of Transplant, Fundación Cardioinfantil-Instituto de Cardiología, Bogota 111321, Colombia

Co-first authors: Felix R Montes and Juan Diego Gutierrez-Navarro.

Co-corresponding authors: Felix R Montes and Laura Gutiérrez-Soriano.

Author contributions: Kling JC, Gutiérrez-Soriano L, Barrera-Lozano LM, and Ramirez-Sanchez N attended the cases and participated in the patient’s treatment; Gutierrez-Navarro JD, Restrepo-Patiño N, Martinez-Ardila R, Diaz-Riaño JN, Becerra-Zapata E, Peña-Blanco L and Gonzalez-Vasquez L collected data and drafted the manuscript, contributed to the literature search, developed the figures and edited the manuscript; All authors participated in discussions and critically revised the manuscript; All authors approved the final version of the manuscript. Both Montes FR and Gutiérrez-Soriano L have played important roles in the manuscript preparation as the co-corresponding authors. Gutiérrez-Soriano L contributed to the conception of the study, the development and design of the algorithm, supervised its implementation, monitored patient adherence to the algorithm, and conducted the literature search. Montes FR contributed to the critical revision of the manuscript through its different versions and was responsible for the preparation and submission of the current version of the manuscript.

AI contribution statement: Grammarly was used only for limited language polishing, including grammar, spelling, punctuation, and stylistic review. It was also used to assist with the English translation and language refinement of tables. No AI tool was used to generate the entirety or any portion of the main text of the manuscript, including the abstract, introduction, materials and methods, results, discussion, or conclusions. No AI tool participated in the design of the study, data collection, data analysis, interpretation of the results, or formulation of the conclusions. All scientific content, analyses, interpretations, and final decisions were developed, reviewed, and approved by the authors. No images, figures, or graphical elements in the manuscript were generated by artificial intelligence. The authors take full responsibility for the accuracy, integrity, and originality of the manuscript.

Institutional review board statement: The study was reviewed and approved by the Fundación Cardioinfantil-La Cardio Institutional Review Board (No. CEIC-100-2025).

Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All authors declare that they have no conflict of interest to disclose.

Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at montes.felix@hotmail.com. Participants gave informed consent for data sharing.

Corresponding author: Felix R Montes, MD, Department of Anesthesiology, Fundación Cardioinfantil-Instituto de Cardiología, Calle 163a #13B-69, Bogota 111321, Colombia. montes.felix@hotmail.com

Received: October 13, 2025
Revised: November 13, 2025
Accepted: January 6, 2026
Published online: June 18, 2026
Processing time: 232 Days and 20.2 Hours

Abstract

BACKGROUND

Simultaneous pancreas-kidney transplantation (SPKT), an established treatment for patients with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) and end-stage renal disease (ESRD), provides metabolic stabilization and improved survival. Although perioperative glycemic control is crucial for graft viability; intraoperative management remains understudied, and standardized phase-specific protocols are lacking.

AIM

To explore the feasibility, safety, and immediate outcomes of a six-phase intraoperative glycemic control algorithm for SPKT.

METHODS

This retrospective case series included 11 patients with T1DM or T2DM and ESRD who underwent SPKT at a quaternary care center between January 2024 and May 2025. All patients were managed using a six-phase institutional glycemic control algorithm that maintains intraoperative blood glucose levels within predefined targets. Data on clinical, metabolic, surgical variables; complications; and early outcomes were collected.

RESULTS

In most cases, intraoperative blood glucose levels were maintained within target ranges; however variations were observed [range: 63-453 mg/dL (3.5-25.2 mmol/L)]. No severe hypoglycemia or ketoacidosis occurred. During the first 24 postoperative hours, seven patients (63.6%) achieved euglycemia without exogenous insulin, whereas two required transient insulin therapy. Six patients (54.5%) had postoperative complications, including thrombotic (n = 4), infectious (n = 2), and reperfusion syndrome (n = 1). One patient experienced more than one event. All events were successfully managed, without graft loss, acute rejection, or in-hospital mortality.

CONCLUSION

The phase-specific intraoperative glycemic protocol for SPKT is feasible and safe. However, prospective studies with larger cohorts are warranted to assess its long-term impact on graft survival and patient outcomes.

Keywords: Simultaneous pancreas-kidney transplantation; Intraoperative glycemic control; Perioperative management; Pancreatic graft function; Metabolic stability

Core Tip: This retrospective study introduces a structured six-phase intraoperative algorithm for metabolic control during simultaneous pancreas-kidney transplantation, defining phase-specific glycemic targets and key decision points from induction to reperfusion. Implemented in 11 consecutive cases, the algorithm proved feasible and safe, maintaining intraoperative glucose within target ranges and avoiding severe hypoglycemia. Most recipients achieved early postoperative euglycemia without exogenous insulin. Visual analysis suggested greater glycemic variability among patients with postoperative complications, underscoring the relevance of intraoperative metabolic stability for graft viability and early recovery.