Single center results of simultaneous pancreas-kidney transplantation in patients with type 2 diabetes

Abstract

Studies have found similar outcomes of Simultaneous Pancreas‐Kidney transplantation (SPKT) in patients with Type 2 (T2D) and Type 1 diabetes (T1D). However, there are scarce data evaluating the association of recipient factors such as age, BMI, or pretransplant insulin requirements with outcomes, thus the criteria for the optimal recipient selection remains unclear. In this study, 284 T1D and 39 T2D patients, who underwent SPKT between 2006 and 2017 with 1 year of follow‐up at minimum, were assessed for potential relationship of pretransplant BMI and insulin requirements with posttransplant diabetes and pancreatic graft failure. Kaplan‐Meier analysis showed similar rates of freedom from posttransplant diabetes (94.7% T2D vs. 92.3% T1D at 1 yr, and 88.1% T2D vs. 81.1% T1D at 5 yrs) and graft survival (89.7% T2D vs. 90.4% T1D at 1 yr, and 89.7% T2D vs. 81.2% T1D at 5 yrs). There was no significant association between BMI or pretransplant insulin requirements with posttransplant diabetes occurrence in either T1D (p = .10, .43, respectively) or T2D (p = .12, .63) patients in the cohort; or with graft failure (T1D: p = .40, .09; T2D: p = .71, .28). These observations suggest a less restricted approach to selective use of SPKT in patients with T2D.

Do pretransplant C‐peptide levels predict outcomes following simultaneous pancreas‐kidney transplantation? A matched case‐control study

“…From 1996 to 2004, there were several case reports in the literature of successful SPKT in “unrecognized” non‐insulin dependent DM, adult onset DM, “lean” T2DM, or “maturity‐onset” DM of the young 11–13,16–18 . Numerous retrospective cohort studies have demonstrated similar survival and functional outcomes in SPKT recipients with either T1DM or T2DM 14,15,19–21,24–26,32–34,39,44–48,50–52 . In these reports, a consistent finding was that in appropriately selected patients with T2DM, the clinical course and outcomes following SPKT were remarkably similar to concurrent patients with T1DM undergoing SPKT.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2020

“…Risk factors for these have been explored, and future research may focus on the potential benefit of modifying these risks preoperatively. 20 Pretransplant BMI and insulin requirement was not associated with the development of posttransplant DM and pancreatic graft failure in SPK candidates with both type 1 or type 2 DM. There was less graft loss in T2DM patients compared with T1DM and successful control of glucose levels and HbA1c% in T2DM recipients, suggesting an expansion of eligibility for SPK to T2DM patients with CKD.…”

“…Fasting glucose and hemoglobin A1c (HbA1c) were comparable in both groups (fasting glucose 90-100 mg/dL, HbA1c < 6%) for at least 3 years. 20 Dean et al previously found high insulin doses (>75 U/day) and BMI (>28 kg/m 2 ) correlated with PTDM after isolated pancreas transplantation, but Pham et al did not for SPK transplant. 20,21 Isolated pancreas transplantation recipients are more prone to PTDM.…”

“…20 Dean et al previously found high insulin doses (>75 U/day) and BMI (>28 kg/m 2 ) correlated with PTDM after isolated pancreas transplantation, but Pham et al did not for SPK transplant. 20,21 Isolated pancreas transplantation recipients are more prone to PTDM. In summary, the researchers found that SPK transplant successfully controlled glucose levels and HbA1c in T2DM recipients, comparable to those of T1DM patients.…”

“…Collectively, these findings support the expansion of eligibility for SPK for T2DM patients with ESRD. 20…”