Prevalence and Management of Potential Candidates for Simultaneous Pancreas-Kidney Transplantation in a Provincial Setting

• Published in: Transplantation proceedings 2007-09, Vol.39 (7), p.2329-2331
• Main Authors: Suñer, M, López-Mendoza, M, Guerrero, A, Del Castillo Páez, M, Montes, R, Delgado, R, Rivera, M, Fernández, G, Jaraba, C, Lara, A, Gentil, M.A
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Creatinine - blood; Diabetes Mellitus, Type 1 - surgery; Diabetes Mellitus, Type 2 - surgery; Diabetic Nephropathies - surgery; Epidemiology; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; General aspects; Humans; Kidney Transplantation - physiology; Kidney Transplantation - statistics & numerical data; Male; Medical sciences; Middle Aged; Pancreas Transplantation - physiology; Pancreas Transplantation - statistics & numerical data; Patient Selection; Prevalence; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Rural Population; Spain; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Tissue, organ and graft immunology; Treatment Outcome; Waiting Lists
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2007.07.040

Abstract Introduction Simultaneous pancreas-kidney (SPK) transplantation is the best therapeutic option for correctly selected diabetic patients with advanced chronic kidney disease (CKD). Objectives The objectives of this study were to quantify in a Spanish province the prevalence and incidence of type 1 and 2 diabetics with stage IV–V CKD who are potential candidates for SPK, and to analyze the selection for SPK in clinical practice. Materials and Methods All patients with diabetic neuropathy (DN) in predialysis, hemodialysis, or peritoneal dialysis (PD) in our transplantation referral area (population, 1.8 million; data collection ended December 7, 2005) were examined for basic SPK criteria (NTO 2005 Consensus). A new assessment was performed 9 months later, including new possible recipients, and patients were classified as: follows in study, excluded after study, added to SPK waiting list, or SPK-transplanted. Results In 2005, there were 1371 patients in dialysis or predialysis, including 179 (13%) with DN (41 type 1 and 138 type 2 DM); only 16 of these patients (8.9% of DN patients), 8.9 per million population (PMP), met the basic criteria for SPK transplantation. There were 68 with DN in predialysis, including 8 (11.7%) possible SPK candidates; 7 with DN in PD, no candidates for SPK; and 104 patients with DN in hemodialysis, including 8 (7.2%) SPK candidates. After 9 months, 7 new potential candidates were identified (incidence of 5.1 PMP/y). Of 23 possible candidates, 3 refused SPK, 7 awaited completion of study, 8 were excluded after study, 1 was on the SPK waiting list, and 7 underwent SPK transplantation. Conclusions In our setting, approximately 9% of DN patients with stage IV–V CKD were potential SPK candidates in 2005 and 2006. After completion of studies, less than half were eventually included on the waiting list, generating an effective demand for SPK of 2–4 new patients PMP/y.