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Simultaneous pancreas–kidney transplant increased survival in type 1 diabetes
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Patients with type 1 diabetes and kidney dysfunction treated with simultaneous pancreas-kidney transplantation had a better survival rate than patients treated with other types of transplants.
Researchers pooled data from nearly 6,900 patient records from the Scientific Registry of Transplant Recipients database. All patients had been on a waiting-list for a transplant between 1997 and 2005. Patient and kidney graft survival were compared with 84-month post-transplant survival.
Transplant recipients were categorized as:
- Recipients of simultaneous pancreas-kidney transplant with functioning pancreas graft at 12 months post-transplant.
- Recipients of simultaneous pancreas-kidney transplant with loss of pancreas graft function within 12 months post-transplant.
- Recipients of deceased-donor kidney alone transplant.
- Recipients of living-donor kidney alone transplant.
Patients with a successful simultaneous pancreas-kidney transplant with a functioning pancreas and kidney at one year had an 88.6% survival rate vs. an 80% survival rate for those treated with a living-donor kidney alone transplant, a 73.9% survival rate for recipients of simultaneous pancreas-kidney transplant with loss of pancreas graft function, and a 64.8% rate for those who received a deceased-donor kidney alone transplant (P<.001).
In addition, unadjusted graft survival rate was highest among the simultaneous pancreas-kidney transplant group (P=.015).
Researchers also reported that patients who received simultaneous pancreas-kidney transplantation were about 2% more likely to die during the first year after transplantation. There was also a 10% to 15% chance that the transplanted pancreas would fail during the first year, decreasing the long-term survival rate to 74%.
“This study helps patients with type 1 diabetes and their providers decide upon the best transplant treatment option,” Alexander Wiseman, MD, director of the University of Colorado Hospital’s Renal Transplant Clinic, said in a press release. “Overall, the chances for better long-term success favor the simultaneous pancreas-kidney transplantation option, particularly if the waiting time for simultaneous pancreas-kidney transplantation is not long.”
In a press release from the American Society of Nephrology, researchers said that the study was limited by the lack of information about why recipients of the simultaneous pancreas-kidney transplantation had better survival.
“One theory is that improved diabetes control helped avoid cardiovascular disease. In addition, although the study provides important new evidence that survival rate is higher after successful [simultaneous pancreas-kidney transplantation], it does not help in predicting which patients will have a successful ... transplant.”
Wiseman A. Clin J Am Soc Nephrol. 2009; doi:10.2215/CJN.04940908.