High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation

• Published in: The American journal of surgery 2021-04, Vol.221 (4), p.677-680
• Main Authors: Torabi, Julia, Melvin, Jeffrey, Rechnitzer, Alma, Rocca, Juan P., Ajaimy, Maria, Lirano-Ward, Luz, Azzi, Yorg, Pynadath, Cindy, Alani, Omar, Akalin, Enver, Graham, Jay A.
• Format: Article
• Language: English
• Subjects: Adult; Age; Biomarkers - blood; Biopsy; Blood groups; Creatinine; Creatinine - blood; Delayed graft function; Demographics; Diabetes; Diabetes mellitus; Diabetes Mellitus - surgery; Donor acute kidney injury; Donor Selection; End-stage renal disease; Female; Glomerular Filtration Rate; Glucose; Graft function; Graft Rejection; Graft Survival; Hemodialysis; Hemoglobin; Humans; Insulin; Kidney diseases; Kidney Failure, Chronic - blood; Kidney Failure, Chronic - surgery; Kidney Transplantation; Kidney transplants; Male; Pancreas; Pancreas Transplantation; Pancreas transplants; Patients; Peptides; Retrospective Studies; Simultaneous pancreas kidney transplantation; Transplants
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.09.031

Simultaneous pancreas and kidney transplantation (SPK) in the setting of end-stage renal disease offers unmatched outcomes in insulin dependent diabetic patients. Donor pool expansion through the transplantation of kidneys with acute kidney injury (AKI) is controversial. 59 SPK transplants were classified by presence of donor AKI, defined as donor terminal creatinine ≥ 1.5x the initial creatinine or donor terminal creatinine > 4.0 mg/dL. Endpoints included graft and patient survival, delayed graft function (DGF), serum creatinine, glomerular filtration rate (GFR), Hemoglobin A1c (HbA1c) and acute rejection. The donor AKI group (n = 35) had significantly higher rates of DGF (38 v. 9%, p = 0.01). There was no difference in creatinine or GFR at 1, 3, 6 and 12 months. HbA1c was comparable at 3, 6 and 12 months. There was no significant difference in the percentage of patients that required anti-diabetic agents after transplant (14 v. 4%, p = 0.56). We observed increased rates of DGF in SPK recipients with donor AKI. However, equivalent outcomes of pancreas and kidney function in both groups were observed. •SPK transplantation from donor’s with AKI can aid in expanding the donor pool.•AKI donors result in increased rates of DGF in SPK recipients.•However, no difference in eGFR at 1,3,6 and 12 month follow up was observed.•No difference in hemoglobin A1c at 3,6 and 12 month follow up was observed.