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

Abstract

ObjectiveTo compare the outcome of simultaneous pancreas-kidney transplantation (SPK) and living related donor renal transplantation (LRD) in patients with diabetes. Summary Background DataIt remains unanswered whether diabetic patients with endstage renal failure are better served by LRD or SPK. MethodsUsing a longitudinal database, data from all diabetic patients receiving LRD or cadaveric renal transplants or SPKs from January 1986 through January 1996 were analyzed. Patient and graft survival, early graft function, and the cause of patient and graft loss were compared for 43 HLA-identical LRDs, 87 haplotype-identical LRDs, 379 SPKs, and 296 cadaveric renal transplants. ResultsThe demographic composition of the SPK and LRD groups were similar, but because of less strict selection criteria in the cadaveric transplant group, patients were 10 years older, more patients received dialysis, and patients had been receiving dialysis longer before transplantation. Patient survival was similar for the SPK and LRD groups but was significantly lower for the cadaveric renal transplant group. Similarly, there was no difference in graft survival between SPK and LRD recipients, but it was significantly lower for recipients in the cadaveric renal transplant group. Delayed graft function was significantly more common in the cadaveric renal transplant group. Discharge creatinine, the strongest predictor of patient and graft survival, was highest in the SPK group and lowest in the HLA-identical LRD group. The rate of rejection within the first year was greatest in SPK patients (77%), intermediate in the haplotype-identical LRD and cadaveric transplant groups (57% and 48%, respectively), and lowest (16%) in the HLA-identical LRD group. Cardiovascular disease was the primary cause of death for all groups. Acute rejection, chronic rejection, and death with a functioning graft were the predominant causes of graft loss. ConclusionsThis study demonstrates that there was no difference in patient or graft survival in diabetic patients receiving LRD or SPK transplants. However, graft and patient survival rates in diabetic recipients of cadaveric renal transplants were significantly lower than in the other groups.

Antibody-Mediated Rejection of the Kidney after Simultaneous Pancreas-Kidney Transplantation

“…1 Excellent short-and long-term patient, kidney, and pancreas survival rates are achieved when the organs are retrieved from young donors. [1][2][3][4][5] In recent years, surgical technical improvements 6 and the introduction of the new immunosuppressive agents tacrolimus and mycophenolate mofetil (MMF) 7 have further improved the short-term results; however, rejection is detrimental to short-and long-term function of any organ transplant. Classical acute T cell rejection (ACR) can be treated effectively with steroids.…”

“…In AMR cases, the treatment was based on (1) Ϫ component was detected in the biopsy. The elimination of DSA with plasmapheresis was undertaken only in some early AMR cases, not in late AMR.…”

The Evaluation of the Renal Transplant Candidates: Clinical Practice Guidelines

“…There has been more experience with simultaneous kidneypancreas transplantation than with other types of pancreatic transplantation. In a recent retrospective comparison of simultaneous kidney-pancreas transplantation with kidney transplant alone (transplanted between 1986 and 1996), there were similar patient and graft survival rates, but lower discharge renal function and a higher rate of acute rejection with simultaneous kidney-pancreas transplantation (955). Information such as this should be part of the shared decision making process for patients and physicians contemplating simultaneous kidney-pancreas versus living-related kidney followed later by a possible cadaveric pancreas transplant.…”

“…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). Nevertheless, newer immunosuppressive regimens have been associated with significant decreases in the reported rates of renal allograft rejection in patients undergoing simultaneous kidney-pancreas transplantation (956,957).…”

Simultaneous pancreas-kidney transplantation: The role in the treatment of type 1 diabetes and end-stage renal disease

“…These include microvascular events, such as retinopathy, neuropathy and nephropathy, and macrovascular diseases involving cerebrovascular, coronary or peripheral vascular systems. 2,3 These complications are largely attributed to hyperglycemia resulting from poor insulin secretion. Consequently, the mortality rate for type 1 DM is high -13% after 20 years of disease.…”