Twelve-Month Pancreas Graft Function Significantly Influences Survival Following Simultaneous Pancreas-Kidney Transplantation

• Published in: Clinical journal of the American Society of Nephrology 2009-05, Vol.4 (5), p.988-995
• Main Authors: Weiss, Andrew S, Smits, Gerard, Wiseman, Alexander C
• Format: Article
• Language: English
• Subjects: Actuarial Analysis; Adult; Diabetes Mellitus, Type 1 - mortality; Diabetes Mellitus, Type 1 - surgery; Female; Graft Survival; Humans; Kaplan-Meier Estimate; Kidney Transplantation - mortality; Kidney Transplantation - statistics & numerical data; Male; Multivariate Analysis; Pancreas Transplantation - mortality; Pancreas Transplantation - statistics & numerical data; Registries; Renal Insufficiency - mortality; Renal Insufficiency - surgery; Renal Transplantation; Risk Factors
• ISSN: 1555-9041; 1555-905X
• DOI: 10.2215/CJN.04940908

Simultaneous pancreas-kidney transplantation (SPK) is regarded as the treatment of choice for type 1 diabetes (T1DM) and kidney dysfunction, despite the morbidity associated with pancreas transplantation. These morbidities often influence selection of SPK versus living-donor kidney alone (LD KA) transplant. This study quantifies the impact of pancreas graft function on outcomes following SPK. Using the SRTR database, SPK wait-listed patients transplanted from 1997 to 2005 were evaluated and segregated as: (1) SPK recipients with functioning pancreas graft 12 mo posttransplant (SPK, P+); (2) SPK recipients with loss of pancreas graft function within 12 mo posttransplant (SPK, P-); (3) recipients of deceased donor (DD) KA; (4) recipients of LD KA. The study compared patient and kidney graft survival to 84 mo posttransplant. Patient survival for SPK, P+ was significantly better than the LD KA; SPK, P-; and DD KA cohorts (88.6% versus 80.0%, 73.9% and 64.8%, respectively [P < 0.001]), a finding confirmed by multivariate analysis and not influenced by pancreas-after-kidney transplantation (PAK) rates and outcomes. Unadjusted graft survival was also highest in the SPK, P+ cohort (72.0% versus 63.6%, 59.8%, 49.7%, P = 0.015 versus LD KA). SPK recipients with functioning pancreas grafts have superior survival compared with LD KA and DD KA, including in the setting of PAK. Early pancreas graft failure results in kidney and patient survival rates similar to KA. These data help further clarify the decision-making of SPK versus KA transplant options for patients and providers.