Simultaneous pancreas-kidney transplant versus kidney transplant alone in diabetic patients

Abstract

The decision for simultaneous pancreas-kidney (SPK) versus kidney transplant alone (KTA) in diabetic patients with renal failure depends on the potential risks and benefits for each procedure. The purpose of this study was to compare the morbidity, mortality, and renal allograft survival in diabetic patients who underwent SPK versus KTA, and to discern the added risks associated with pancreas transplantation. Between 7/1/86 and 9/30/90, 69 primary cadaver SPK and 59 primary cadaver KTA were performed in type I diabetic patients with chronic renal failure. Antilymphocyte globulin or OKT3 was used for induction therapy, followed by standard triple therapy (prednisone, azathioprine, and cyclosporine). Patient and graft survivals were retrospectively analyzed. In addition, a detailed comparison of morbidity in those patients treated after 7/1/87 was performed (53 SPK, 49 KTA). For those less than 45 years of age (65 SPK, 42 KTA), there were no significant differences (P greater than 0.6) in the actuarial patient survival at one year (SPK 92%, KTA 95%), or two years (SPK 89%, KTA 92%), or actuarial renal allograft survival at one year (SPK 82%, KTA 83%) or two years (SPK 77%, KTA 83%). However, for those greater than 45 years old, actuarial renal allograft survival was significantly higher (P less than 0.03) in the KTA group. The mean serum creatinine levels were similar at one year (SPK 1.8, KTA 1.9 mg/d).(ABSTRACT TRUNCATED AT 250 WORDS)

Simultaneous Pancreas-Kidney Transplantation and Living Related Donor Renal Transplantation in Patients With Diabetes: Is There a Difference in Survival?

“…Several other comparisons of SPK and cadaveric renal transplantation in diabetic patients have been published. Cheung et al 27 from Minnesota showed that for patients younger than 45 years, there was no difference in 2-year patient or graft survival rates, but older patients receiving cadaveric kidneys alone fared significantly better than older SPK recipients. The Iowa group, who analyzed a cohort of patients younger than 45 years, showed no difference in long-term survival between cadaveric and SPK recipients.…”

Effect of Ethnicity on Outcome of Simultaneous Pancreas and Kidney Transplantation

“…We therefore believe that the late pancreas graft losses secondary to chronic rejection in AA most likely result from inadequate treatment of pancreas rejection episodes rather than from a failure of rejection surveillance. It is well known that rejection is not only more common in SPK, but also more likely to be steroid resistant and recurrent than in kidney transplant alone (43)(44)(45). Papadimitriou et al have shown while minimal and mild episodes of pancreas rejection have a good response to steroids, higher grades of rejection are more likely to be steroid resistant and require antibody therapy (46).…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…Infections are more common in kidney-pancreas transplant recipients compared to kidney transplantation alone (950,952,953). Simultaneous kidney-pancreas transplantation has been associated with a higher incidence of acute renal allograft rejection (954,955).…”