Influence of dialysis duration on outcomes of simultaneous pancreas‐kidney transplant

Abstract

According to the data of the International Diabetes Federation, the global diabetic population was 463 million in 2019, and it is estimated to reach 700 million in 2045. 1 Type 1 diabetes mellitus (T1DM) accounts for approximately 5%-10% of the diabetic population. 2 One of the severe complications of T1DM is end-stage renal disease, which requires dialysis or kidney transplant. 3 Further, diabetes is one of the most common causes of end-stage renal disease in the United States. 4 Pancreas transplantation has evolved from an experimental method into standard treatment for patients with uremia and diabetes. Simultaneous pancreas-kidney (SPK) transplant in patients

Preemptive simultaneous pancreas kidney transplantation has survival benefit to patients

“…[6][7][8][9][10] Moreover, according to the results of previous studies, preemptive SPK seems to be associated with better results as compared with a non-preemptive strategy. 14,19 Despite the potential benefits provided by preemptive SPK, the proportion of patients with ACKD and DM who are transplanted in a predialysis status remains significantly low. 6,14,15 This scenario has not substantially changed during the past years despite increasing evidence in favor of preemptive SPK, mostly because patients are still referred to SPK pretransplant evaluation specialized units when kidney disease is severely advanced and dialysis onset is imminent.…”

“…14,19 Despite the potential benefits provided by preemptive SPK, the proportion of patients with ACKD and DM who are transplanted in a predialysis status remains significantly low. 6,14,15 This scenario has not substantially changed during the past years despite increasing evidence in favor of preemptive SPK, mostly because patients are still referred to SPK pretransplant evaluation specialized units when kidney disease is severely advanced and dialysis onset is imminent. 6,14,15 Although waiting time for an SPK has decreased in a most recent era, 26,27 the historical longer waiting time for an SPK than for those receiving pancreas after kidney transplantation may have further contributed to the late referral.…”

“…Some studies have previously assessed the potential benefits associated with preemptive SPK. [14][15][16][17][18][19]31 Israni et al 19 retrospectively explored the influence of preemptive SPK on kidney graft survival in a large cohort of SPK recipients and observed that preemptive SPK (vs. non-preemptive SPK) was associated with a significantly lower rate of kidney graft failure (20% decrease). Similarly, Becker et al 32 reported that preemptive SPK was associated with lower recipient mortality (50% decrease) and kidney graft loss (13% decrease) in patients with T1D.…”

“…In kidney transplantation, long-term dialysis demonstrated to negatively affect transplant outcomes and it has been associated with an increased risk of recipient mortality and kidney graft failure after transplantation. [33][34][35] Dong et al 14 assessed the influence of pre-SPK dialysis time on recipient and kidney and pancreas graft outcomes in a cohort of 6887 SPK recipients. They reported that a dialysis duration of >2 years before SPK significantly increased the risk of recipient and kidney graft survival whereas shorter periods (0-2 years) did not.…”

“…The benefits of preemptive SPK in patients with ACKD and DM remains controversial, especially according to the data published in recent studies. [14][15][16][17][18][19] This information is crucial toward patient referral to transplant centers and organ allocation policies. Several national organ allocation policies try to mitigate this increase in cardiovascular risk through a priority toward patients in the SPK transplant waiting list.…”