The survival advantage of pancreas after kidney transplant

Abstract

Patient survival after pancreas after kidney transplant (PAK) has been reported to be inferior to patient survival after simultaneous pancreas-kidney transplant (SPK). The authors examine national data to further explore allograft (kidney and pancreas) and patient survival after PAK. Kaplan-Meier and Cox proportional hazard models were used to analyze Organ Procurement and Transplantation Network data from 1995 to 2010. The analysis compared PAK and SPK candidates and recipients. Kaplan-Meier analysis results showed that PAK after either a living or a deceased donor kidney transplant is associated with increased kidney graft survival compared with recipients with type 1 diabetes who received only a kidney. The best kidney allograft survival was for patients who received a living donor kidney followed by PAK. Receiving a living donor kidney was associated with increased pancreas allograft survival compared with receiving a deceased donor kidney. PAK transplant recipients who receive both organs have a survival advantage compared with uremic candidates who receive neither (SPK waitlist). Compared with uremic diabetic waitlist patients, SPK and PAK recipients showed similar overall patient survival. Successful PAK offers a survival advantage compared with receiving neither a kidney nor a pancreas transplant. These data also suggest that receiving a pancreas (after kidney) transplant may have a protective effect on the kidney allograft.

Outcomes of pancreas transplantation in older diabetic patients

“…Nevertheless, one of the most important adverse events which was most frequently reported in the intensive care group was hypoglycemia 18. In this sense, PT is an alternative treatment to selected patients with diabetes which is able to achieve euglycemia with a low risk of hypoglycemia and that has demonstrated to improve patient survival19 20 and reduce cardiovascular-related death compared with kidney transplant alone 21. The observational study phase (EDIC study) following the DCCT demonstrated major long-term benefits for the intensive treatment group of the DCCT compared with controls, particularly regarding microvascular and macrovascular complications, including MACE 16–18 22–25…”

Pancreas allocation and diabetic end-stage kidney disease

“…Both modalities of pancreas after kidney (PAK) transplant are associated with increased kidney graft survival compared with T1DM recipients who receive only a kidney. 10 LDK+PAK present superior graft survival than DDK+PAK. 10 Likewise, an analysis of the UK Transplant Registry on all SPK (n=1739) and LDK (n=385) transplants performed in the UK between 2001 and 2014 showed that SPK recipients with a functioning pancreas at 90 days present a better long-term patient survival and comparable kidney graft survival than LDK recipients.…”

“…10 LDK+PAK present superior graft survival than DDK+PAK. 10 Likewise, an analysis of the UK Transplant Registry on all SPK (n=1739) and LDK (n=385) transplants performed in the UK between 2001 and 2014 showed that SPK recipients with a functioning pancreas at 90 days present a better long-term patient survival and comparable kidney graft survival than LDK recipients. 5 Thus, it seems that receiving a pancreas transplant may have a protective effect on the kidney allograft as glycemic control limits progression of microscopic lesions of diabetic nephropathy.…”

“…In the setting of contradictory data, a recent analysis of the Organ Procurement and Transplantation Network (OPTN) data from 1995 to 2010 comprising over 12,000 SPK and 3,000 PAK transplants performed in the United States (US), has shown that SPK recipients presented a higher survival than PAK recipients, at 10 years post-transplant (70.3% vs 63.2% and P <0.001). 10,12 While SPK remains, perhaps, the preferable transplant modality due to increased survival outcomes, if waiting time for an SPK is expected to be prolonged, LDK+PAK remains a reasonable approach, as it decreases waiting time and exposure to uremia 3,[11][12] Islet Cell Transplantation…”

Machine Perfusion and the Pancreas: Will It Increase the Donor Pool?

“…As of yet, no randomized controlled trial (RCT) has compared SPK vs kidney transplantation alone, or PTA vs intensive insulin therapy. Multiple single-centre reports and registry analyses however suggest a survival benefit compared with isolated kidney transplantation in recipients with diabetes and kidney impairment [18–20]. The potential impact and risk however of pancreas transplantation on patient survival and kidney function in patients with diabetes but preserved renal function (i.e.…”