Metabolic outcomes and renal function after simultaneous kidney/pancreas transplantation compared with kidney transplantation alone for type 2 diabetes mellitus patients

Abstract

In this study, we aimed to compare the metabolic outcomes, renal function, and survival outcomes of simultaneous pancreas and kidney transplantation (SPK) and kidney transplantation alone (KTA) among endstage kidney disease (ESKD) patients with type II diabetes mellitus (T2DM). Patients with ESKD and T2DM who underwent KTA (n = 85) or SPK (n = 71) in a transplant center were retrospectively reviewed. Metabolic profiles, renal function, and survival outcomes were assessed repeatedly at different follow-up time points. Propensity score procedures were applied to enhance between-group comparability. The levels of renal and metabolic outcomes between SPK and KTA over time were examined and analyzed using mixed-model repeated-measures approaches. The median follow-up period was 1.8 years. Compared with KTA, SPK resulted in superior metabolic outcomes and renal function, with lower levels of glycated hemoglobin (HbA1c; P = 0.0055), fasting blood glucose (P < 0.001), triglyceride (P = 0.015), cholesterol (P = 0.0134), low-density lipoprotein (P = 0.0161), and higher estimated glomerular filtration rate (eGFR; P < 0.001). SPK provided better metabolic outcomes and renal function. The survival outcomes of the recipients and grafts were comparable between the two groups.

Simultaneous pancreas and kidney transplantation for end-stage kidney disease patients with type 2 diabetes mellitus: a systematic review and meta-analysis

“…Sixty-nine full texts were excluded next due to lack of survival outcomes of patients or grafts, leaving 16 eligible publications. Next, among the 16 studies, 9 were involved in the difference data synthesis process [11,[15][16][17][18][19][26][27][28]. Considering the study quality and data completeness on primary outcomes, 6 were included for synthesizing survival outcomes of T2MD patients after SPK [11, 15-17, 19, 26-28], 6 studies were included for summarizing the hazard ratio between T1DM and T2DM after SPK [15][16][17][18][19]28], 3 studies were included for synthesizing hazard ratio between the SPK group and the KTA group [16,26,28], and each meta-analysis had no overlapping samples.…”

“…Hitherto, no high-quality evidence was available for T2DM patients with SPK, neither the precise survival risks of T2DM patients undertaking SPK compared with T1DM SPK patients or T2DM KTA patients. With several studies from different countries emerging between 2016 and 2020 [17,18,[26][27][28], this study conducted a systematic review and meta-analysis to identify, collect, and synthesize all evidence reporting the survival outcomes of T2DM-ESKD recipients undertaking SPK worldwide, and make comparisons with their T1DM and KTA counterparts. This systemic review included 9 studies comprising 811 T2DM-SPK recipients.…”

“…As shown in Table 2, a variety of DM definitions has been witnessed among the included studies. Studies adopted center-specific criteria in selecting DM candidates for SPK [16,17,[26][27][28], which classified DM around the C-peptide level, BMI of 30 kg/m 2 , age, and pancreatic antibodies [15-17, 19, 29-31]. UNOS's definition of T2DM was based on the SPK transplant recipient registration form and the diagnosis of end-stage pancreas disease (ESPD) [15].…”

“…Six studies [11,16,17,19,[26][27][28] were included for meta-analysis of survival rates of SPK among T2DM recipients (Fig. 2A-C).…”

“…after SPK compared with KTA (Fig. 4A-B) Four studies were included for meta-analysis of survival outcome comparison between SPK and KTA among T2DM patients [16,[26][27][28] (Fig. 4A-B).…”