Twelve-Month Pancreas Graft Function Significantly Influences Survival Following Simultaneous Pancreas-Kidney Transplantation

Weiss, Andrew S.; Smits, Gerard; Wiseman, Alexander C.

doi:10.2215/cjn.04940908

Cited by 90 publications

(73 citation statements)

References 33 publications

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“…A pancreas graft loss is inversely associated with long-term survival. As shown by Weiss et al [13], Morath et al [14] and Salvalaggio et al [36], success of dual transplantation (SPK) depends on a long-term functioning pancreas graft. This is consistent with our findings of lower mortality in SPK recipients with a functioning pancreas graft 1 year post transplant compared with those recipients with a failing pancreas graft 1 year post transplant.…”

Section: Discussionmentioning

confidence: 99%

“…The obvious benefit of a functioning pancreas graft is normalised blood glucose control without the use of insulin, compared with consistent moderate hyperglycaemia controlled with insulin use. The question whether cardiovascular outcomes can be improved by transplanting a pancreas simultaneously with the kidney remains, however, controversial [11][12][13][14]. A major obstacle when comparing outcomes following SPK vs kidney transplantation alone (KTA; from either a deceased or a living donor) in recipients with type 1 diabetes has been imbalance in risk factors between patient populations, particularly due to selection of younger patients with less comorbidity for SPK transplantation.…”

Section: Introductionmentioning

confidence: 99%

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Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

et al. 2015

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Aims/hypothesis Mortality due to cardiovascular disease (CVD), particularly coronary artery disease (CAD), is high in type 1 diabetic patients with end-stage renal disease (ESRD). We aimed to determine whether normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, could improve long-term outcomes compared with living donor kidney-alone (LDK) transplantation. Methods We studied 486 type 1 diabetic patients with ESRD who underwent a first SPK (n = 256) or LDK (n = 230) transplant between 1983 and 2012 and were followed to the end of 2014. Data were retrieved from the Norwegian Renal Registry and hospital records. Kaplan-Meier plots and multivariate Cox regression, with correction for recipient, donor and transplant factors, were used to examine potential associations between transplant type and all-cause and CVD-and CADrelated mortality. Results Median follow-up time was 7.9 years (interquartile range 4.3, 12.9). The adjusted HR for CVD-related deaths in SPK recipients compared with LDK recipients was 0.63 (95% CI 0.40, 0.99; p = 0.047), while the HRs for all-cause and CAD-related mortality were 0.81 (95% CI 0.57, 1.16; p = 0.25) and 0.63 (95% CI 0.36, 1.12; p = 0.12), respectively. Compared with the LDK group, SPK recipients were younger and received grafts from younger donors. Cardiovascular mortality was higher in patients transplanted between 1983 and 1999 compared with those who received their grafts in subsequent years. Conclusions/interpretation In patients with type 1 diabetes and ESRD, SPK transplantation was associated with reduced long-term cardiovascular mortality compared with LDK transplantation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

et al. 2015

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“…This controversy is highlighted by three recent publications authored by Young et al (1), Weiss et al (2), and our group (3). Analyzing data from large registries, all three studies compared kidney graft and patient survival in SPK (all from deceased organ donors) and KTA transplants, whereby the KTA grafts were from deceased (DDK) or living donors (LDK).…”

mentioning

confidence: 99%

Transplantation of the Type 1 Diabetic Patient

Morath

Zeier²,

Döhler³

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…The survival benefit of SPK over DDKA has been consistently reported for T1DM recipients, with difference in survival noted as early as 12 months after transplantation (13). This benefit appears to be related to both kidney donor quality and a functional pancreas transplant for the first era (approximately 5 years) after transplantation (2,14). However, in a large retrospective analysis of T1DM recipients, after 5 years SPK was associated with a reduction in mortality risk, and after 10 years, with a reduction in risk for kidney graft loss, suggesting that over time the benefits of SPK become more evident (3,15).…”

Section: Discussionmentioning

confidence: 80%

“…With 1-year patient and pancreas graft survival rates of 96% and 85%, respectively (1) and evidence of long-term advantages of functional pancreas transplantation upon survival compared with living-donor and deceased-donor kidney transplantation alone (2,3), an argument can be made that SPK is the transplantation option of choice for patients with type 1 diabetes mellitus (T1DM).…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Pancreas Kidney Transplant versus Other Kidney Transplant Options in Patients with Type 2 Diabetes

Wiseman¹,

Gralla

2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Current organ allocation policy prioritizes placement of kidneys (with pancreas) to patients listed for simultaneous pancreas-kidney transplantation (SPK). Patients with type 2 diabetes mellitus (T2DM) may undergo SPK, but it is unknown whether these patients enjoy a survival advantage with SPK versus deceased-donor kidney transplantation alone (DDKA) or living-donor kidney transplantation alone (LDKA).Design, setting, participants, & measurements Using the Scientific Registry of Transplant Recipients database, patients with T2DM, age 18-59 years, body mass index 18-30 kg/m 2 , who underwent SPK, DDKA, or LDKA from 2000 through 2008 were identified. Five-year patient and kidney graft survival rates were compared, and multivariable analysis was performed to determine donor, recipient, and transplant factors influencing these outcomes.Results Of 6416 patients identified, 4005, 1987, and 424 underwent DDKA, LDKA, and SPK, respectively. On unadjusted analysis, patient and kidney graft survival rates were superior for LDKA versus SPK, whereas patient but not graft survival was higher for SPK versus DDKA. On multivariable analysis, survival advantage for SPK versus DDKA was related not to pancreas transplantation but younger donor and recipient ages in the SPK cohort.Conclusions Good outcomes can occur with SPK in selected patients with T2DM, but no patient or graft survival advantage is provided by added pancreas transplantation compared with DDKA; outcomes were superior with LDKA. These results support cautious use of SPK in T2DM when LDKA is not an option, with close oversight of the effect of kidney (with pancreas) allocation priority over other transplant candidates.

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Twelve-Month Pancreas Graft Function Significantly Influences Survival Following Simultaneous Pancreas-Kidney Transplantation

Cited by 90 publications

References 33 publications

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

Transplantation of the Type 1 Diabetic Patient

Simultaneous Pancreas Kidney Transplant versus Other Kidney Transplant Options in Patients with Type 2 Diabetes

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