Impact of Acute Rejection Episodes on Long-Term Graft Survival Following Simultaneous Kidney-Pancreas Transplantation

Abstract

Although it is well established that acute rejection is one of the major risk factors for chronic graft loss following kidney transplantation, its effect on longterm graft survival following simultaneous kidneypancreas transplants (SKPTs) is less well known. We analyzed a large cohort of SKPTs and cadaver kidney transplants reported to the United Network for Organ Sharing database during 1988±97, to determine the impact of acute rejection episodes on long-term kidney and pancreas graft survival. Only patients whose kidney and pancreas grafts had survived for at least 1 year were included. Other potential risk factors influencing long-term graft survival were included in the analysis. Of the 4251 SKPTs, 45% had no acute rejection, 36% had kidney only rejection, 3% had pancreas only rejection, and 16% had both kidney and pancreas rejection within the 1st year post transplant. The 5-year kidney and pancreas graft survival rates adjusted for other risk factors were 91% and 85%, respectively; for those with no acute rejection episodes, 88% and 84%, respectively; for those with kidney only rejection, 94% and 83%, respectively; for those with pancreas only rejection; and 86% and 78%, respectively, for those with both kidney and pancreas rejection. The relative risk (RR) of kidney graft failure was 1.32 when acute rejection involved the kidney graft only, while the RR was 1.53 when the rejection involved both organs. We conclude that acute rejection episodes have a negative impact on the long-term kidney graft survival in the SKPT population similar to that in the cadaver kidney transplant population. Patients who had acute rejection episodes of both kidney and pancreas have the worst long-term graft survival.

Impacto da função retardada do enxerto pancreático no transplante simultâneo pâncreas-rim

“…When considering the 4,251 recipients of simultaneous pancreas-kidney transplantation notified in the North American registration UNOS, 36% presented at least one episode of renal acute rejection, 3% had at least one episode of pancreatic rejection, and 16% presented rejection in both grafts simultaneously. 22 DPGF is significantly associated with lower pancreatic survival rates, 8 especially when there is an activation of the immune system, reduced pancreatic mass (in older donors), as well as ischemia and reperfusion lesions. 8 Episodes of intra-abdominal infections, vascular thrombosis and renal acute rejection are also known as factors related to lower pancreatic survival rates in the short-term (1 year of follow-up).…”

Pancreatic transplantation: Beta cell replacement

“…Impaired glucose metabolism is also a potential side effect and needs to be considered in patients undergoing beta cell replacement [9]. Special points Drug levels have to be monitored and kept carefully within target levels to avoid rejection [10,11]. The dose often has to be titrated to reduce side effects of nephro-or neurotoxicity.…”

Transplante de pâncreas e ilhotas em portadores de diabetes melito

“…De acordo com os dados da UNOS, no primeiro ano, 45% dos pacientes submetidos ao TSPR não apresentam rejeição aguda, 36% têm rejeição aguda apenas renal, 3% têm rejeição aguda apenas pancreática e 16% apresentam rejeição aguda nos dois enxertos (33) (34,35).…”