Cardiovascular outcomes after simultaneous pancreas kidney transplantation compared to kidney transplantation alone: a propensity score matching analysis

Abstract

Background Coronary heart disease due to arteriosclerosis is the leading cause of death in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to evaluate the effect of simultaneous pancreas kidney transplantation (SPKT) compared to kidney transplantation alone (KTA) on survival, cardiovascular function and metabolic outcomes. Methods A cohort of 127 insulin-dependent diabetes mellitus (IDDM) patients with ESRD who underwent either SPKT (n = 100) or KTA (n = 27) between 1998 and 2019 at the University Hospital of Leipzig were retrospectively evaluated with regard to cardiovascular and metabolic function/outcomes as well as survival rates. An additional focus was placed on the echocardiographic assessment of systolic and diastolic cardiac function pretransplant and during follow-up. To avoid selection bias, a 2:1 propensity score matching analysis (PSM) was performed. Results After PSM, a total of 63 patients were identified; 42 patients underwent SPKT, and 21 patients received KTA. Compared with the KTA group, SPKT recipients received organs from younger donors (p < 0.05) and donor BMI was higher (p = 0.09). The risk factor-adjusted hazard ratio for mortality in SPKT recipients compared to KTA recipients was 0.63 (CI: 0.49–0.89; P < 0.05). The incidence of pretransplant cardiovascular events was higher in the KTA group (KTA: n = 10, 47% versus SPKT: n = 10, 23%; p = 0.06), but this difference was not significant. However, the occurrence of cardiovascular events in the SPKT group (n = 3, 7%) was significantly diminished after transplantation compared to that in the KTA recipients (n = 6, 28%; p = 0.02). The cardiovascular death rate was higher in KTA recipients (19%) than in SPK recipients with functioning grafts (3.3%) and comparable to that in patients with failed SPKT (16.7%) (p = 0.16). In line with pretransplant values, SPKT recipients showed significant improvements in Hb1ac values (p = 0.001), blood pressure control (p = < 0.005) and low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio (p = < 0.005) 5 years after transplantation. With regard to echocardiographic assessment, SPKT recipients showed significant improvements in left ventricular systolic parameters during follow-up. Conclusions Normoglycaemia and improvement of lipid metabolism and blood pressure control achieved by successful SPKT are associated with beneficial effects on survival, cardiovascular outcomes and systolic left ventricular cardiac function. Future studies with larger samples are needed to make predictions regarding cardiovascular events and graft survival.

Surgical complications and technical failure of simultaneous pancreas‐kidney transplantation: A 22‐year experience from a single center

“…Studies consistently demonstrate its superiority in prolonging patient survival, reducing the development and progression of peripheric vascular disease, and reducing mortality rates compared to alternative treatments for end-stage renal disease and insulin-dependent diabetes mellitus. [4][5][6][7] Over the last decades, SPKT outcomes have improved, thanks to technical advances, better donor and recipient selection, new immunosuppressive agents, and increased knowledge regarding the management of complications. [8][9][10][11] Despite the promising results, it should be noted that SPKT is a complex procedure that can lead to surgical complications resulting in graft loss, impaired kidney function, increased recipient mortality, and an extended hospital length of stay (LOS).…”

Favorable outcomes in Hispanic recipients receiving simultaneous pancreas kidney transplantation

“…The prevalence of diabetes and diabetic ESRD continues to increase significantly in ethnic groups, including Hispanics 1,2 . A simultaneous pancreas and kidney transplant (SPKT) restores euglycemia without insulin and improves the quality of life, metabolic profiles, and cardiovascular health 3–8 . Recent studies have reported advancements in surgical techniques for pancreas transplants, resulting in fewer complications 9–11 …”

“…1,2 A simultaneous pancreas and kidney transplant (SPKT) restores euglycemia without insulin and improves the quality of life, metabolic profiles, and cardiovascular health. [3][4][5][6][7][8] Recent studies have reported advancements in surgical techniques for pancreas transplants, resulting in fewer complications. [9][10][11] Hispanics are the largest minority in the United States (18%) and are predicted to comprise 30% of the US population by 2050.…”

Favorable Outcomes in Older Recipients Receiving Simultaneous Pancreas Kidney Transplantation

“…Simultaneous kidney and pancreas transplant further improves the quality of life, with a better metabolic and cardiovascular profile. 2-6…”

“…Simultaneous kidney and pancreas transplant further improves the quality of life, with a better metabolic and cardiovascular profile. [2][3][4][5][6] Although a successful pancreas transplant is associated with better glucose homeostasis and its advantages, it has a potentially increased risk of surgical complications. Most centers use a cutoff of 50 y of age as a criterion for simultaneous pancreas kidney transplantation (SPKT).…”