Successful Long-Term Kidney-Pancreas Transplants in Diabetic Patients With High C-Peptide Levels

Tm, Sasaki; Rs, Gray; Re, Ratner; Currier, C; Aquino, A; Dy, Barhyte; Ja, Light

doi:10.1097/00007890-199806150-00021

Cited by 43 publications

(36 citation statements)

References 8 publications

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“…Even uremic patients with type 2 diabetes have routinely received SPK transplants in some programs. 261 We, too, have found no difference in insulin independence rates in the few type 2 diabetic patients we have transplanted.…”

Section: Discussionmentioning

confidence: 72%

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

612

434

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ObjectiveTo determine outcome in diabetic pancreas transplant recipients according to risk factors and the surgical techniques and immunosuppressive protocols that evolved during a 33-year period at a single institution. Summary Background DataInsulin-dependent diabetes mellitus is associated with a high incidence of management problems and secondary complications. Clinical pancreas transplantation began at the University of Minnesota in 1966, initially with a high failure rate, but outcome improved in parallel with other organ transplants. The authors retrospectively analyzed the factors associated with the increased success rate of pancreas transplants. MethodsFrom December 16, 1966, to March 31, 2000, the authors performed 1,194 pancreas transplants (111 from living donors; 191 retransplants): 498 simultaneous pancreas-kidney (SPK) and 1 simultaneous pancreas-liver transplant; 404 pancreas after kidney (PAK) transplants; and 291 pancreas transplants alone (PTA). The analyses were divided into five eras: era 0, 1966 to 1973 (n ϭ 14), historical; era 1, 1978 to 1986 (n ϭ 148), transition to cyclosporine for immunosuppression, multiple duct management techniques, and only solitary (PAK and PTA) transplants; era 2, 1986 to 1994 (n ϭ 461), all categories (SPK, PAK, and PTA), predominately bladder drainage for graft duct management, and primarily triple therapy (cyclosporine, azathioprine, and prednisone) for maintenance immunosuppression; era 3, 1994 to 1998 (n ϭ 286), tacrolimus and mycophenolate mofetil used; and era 4, 1998 to 2000 (n ϭ 275), use of daclizumab for induction immunosuppression, primarily enteric drainage for SPK transplants, pretransplant immunosuppression in candidates awaiting PTA. ResultsPatient and primary cadaver pancreas graft functional (insulinindependence) survival rates at 1 year by category and era were as follows: SPK, era 2 (n ϭ 214) versus eras 3 and 4 combined (n ϭ 212), 85% and 64% versus 92% and 79%, respectively; PAK, era 1 (n ϭ 36) versus 2 (n ϭ 61) versus 3 (n ϭ 84) versus 4 (n ϭ 92), 86% and 17%, 98% and 59%, 98% and 76%, and 98% and 81%, respectively; in PTA, era 1 (n ϭ 36) versus 2 (n ϭ 72) versus 3 (n ϭ 30) versus 4 (n ϭ 40), 77% and 31%, 99% and 50%, 90% and 67%, and 100% and 88%, respectively. In eras 3 and 4 combined for primary cadaver SPK transplants, pancreas graft survival rates were significantly higher with bladder drainage (n ϭ 136) than enteric drainage (n ϭ 70), 82% versus 74% at 1 year (P ϭ .03). Increasing recipient age had an adverse effect on outcome only in SPK recipients. Vascular disease was common (in eras 3 and 4, 27% of SPK recipients had a pretransplant myocardial infarction and 40% had a coronary artery bypass); those with no vascular disease had significantly higher patient and graft survival rates in the SPK and PAK categories. Living donor segmental pancreas transplants were associated with higher technically successful graft survival rates in each era, predominately solitary (PAK and PTA) in eras 1 and 2 and SPK in eras 3 and 4. Diabetic seconda...

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Section: Discussionmentioning

confidence: 72%

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Sutherland¹,

Gruessner²,

Dünn³

et al. 2001

Annals of Surgery

612

434

View full text Add to dashboard Cite

show abstract

“…The largest published study included 38 SPK T2DM recipients, defined by a serum C-peptide level Ͼ0.8 ng/ml (12)(13)(14). In T1DM and T2DM, 5-year patient survival was 85% and 73%, pancreas survival was 71% and 67%, and kidney survival was 77% and 72%, respectively.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Simultaneous Pancreas-Kidney Transplantation in Type 2 Diabetic Recipients

Sampaio

Kuo

Bunnapradist

2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Type 2 diabetic patients with end-stage renal disease may receive a simultaneous pancreas-kidney (SPK) transplant. However, outcomes are not well described. Risks for death and graft failure were examined in SPK type 2 diabetic recipients.Design, setting, participants, & measurements Using the United Network for Organ Sharing database, outcomes of SPK transplants were compared between type 2 and type 1 diabetic recipients. All primary SPK adult recipients transplanted between 2000 and 2007 (n ϭ 6756) were stratified according to end-stage pancreas disease diagnosis (type 1: nϭ6141, type 2: nϭ582). Posttransplant complications and risks for death and kidney/pancreas graft failure were compared. ResultsOf the 6756 SPK transplants, 8.6% were performed in recipients with a type 2 diabetes diagnosis. Rates of delayed kidney graft function and primary kidney nonfunction were higher in the type 2 diabetics. Five-year overall and death-censored kidney graft survival were inferior in type 2 diabetics. After adjustment for other risk factors, including recipient (age, race, body weight, dialysis time, and cardiovascular comorbidities), donor, and transplant immune characteristics, type 2 diabetes was not associated with increased risk for death or kidney or pancreas failure when compared with type 1 diabetic recipients. ConclusionsAfter adjustment for other risk factors, SPK recipients with type 2 diabetes diagnosis were not at increased risk for death, kidney failure, or pancreas failure when compared with recipients with type 1 diabetes.

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“…Light et al identified a small subset of SPKT recipients with ESRD and DM with high C-peptide levels (>1.37 ng/mL in the initial study, >0.8 ng/mL in followup data). Retrospective analysis demonstrated no significant differences in allograft (pancreas and kidney) and patient survival out to 10 years, as compared to patients with low Cpeptide levels [15][16][17]. However, Singh et al demonstrated worse patient survival but equivalent graft survival in SPKT recipients with T2DM (C-peptide >2.0 ng/mL) versus T1DM (<2.0 ng/mL) at the time of transplant [18].…”

Section: Pancreas Transplantation For Type 2 Diabetes Mellitusmentioning

confidence: 98%

Pancreas Transplantation of Non-Traditional Recipients

Sayed

Turgeon

2014

Curr Transpl Rep

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Solid organ pancreas transplantation is a durable treatment for establishing normal blood glucose levels in patients with diabetes. Historically, younger patients with type 1 diabetes have been the primary recipients of pancreas transplants. As surgical techniques and post-operative immunosuppression regimens have continued to improve, indications have expanded such that non-traditional recipients are being evaluated for pancreas transplantation. These recipients include patients with type 2 diabetes, patients older than 50 years of age, and patients with chronic infectious diseases, including HIV and HCV. Despite limited literature in these patient populations, pancreas transplantation is a viable treatment for endocrine pancreas failure in appropriately selected patients, regardless of disease etiology or age. This review summarizes the current literature on pancreas transplantation in non-traditional recipients.

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Successful Long-Term Kidney-Pancreas Transplants in Diabetic Patients With High C-Peptide Levels

Abstract: Long-term pancreas graft function is attainable and beta cell "exhaustion" does not occur in patients with high preoperative C-peptide (>1.37 ng/ ml) levels. AA and non-AA patients have equivalent long-term patient, kidney, and pancreas-kidney graft survival rates.

Cited by 43 publications

References 8 publications

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Lessons Learned From More Than 1,000 Pancreas Transplants at a Single Institution

Outcomes of Simultaneous Pancreas-Kidney Transplantation in Type 2 Diabetic Recipients

Pancreas Transplantation of Non-Traditional Recipients

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