Impact of pre-transplant dialysis modality on the outcome and health-related quality of life of patients after simultaneous pancreas-kidney transplantation

Abstract

Background Simultaneous pancreas-kidney transplantation (SPKT) profoundly improves the Health-related quality of life (HRQoL) of the recipients. However, the influence of the pre-transplant dialysis modality on the success of the SPKT and post-transplant HRQoL is still unknown. Methods We analyzed the surgical outcome, long-term survival, as well as HRQoL of 83 SPKTs that were performed between 2000 and 2016 in our Hospital. Prior to transplant, 63 patients received hemodialysis (HD) and 19 patients received peritoneal dialysis (PD). Physical and mental quality of life results from eight basic scales and the physical and mental component summaries (PCS and MCS) were measured using the Short Form 36 (SF-36) survey. Results Peri- and postoperative complications, as well as patient and graft survival were similar in both groups. Both groups showed improvement of HRQoL in all SF-36 domains after transplantation. Compared to patients who received HD before transplantation, PD-patients showed significantly better results in five of the eight SF-36 domains: physical functioning (P = 0.02), bodily pain (P = 0.001), general health (P = 0.038), vitality (P = 0.014), role limitations emotional (P = 0.048) and PCS (P = 0.002) after SPKT. In the overall study population, graft loss was associated with significant worsening of the HRQoL in all physical components (each P < 0.01). Conclusions The results of this analysis show that pre-transplant dialysis modality has no influence on outcome and survival rate after SPKT. Regarding HRQoL, patients receiving PD prior to SPKT seems to entail a slight advantage compared to patients with HD before transplantation.

Transplant Options for Patients With Diabetes and Advanced Kidney Disease: A Review

“…37 More recent studies compared QoL before and after SPK and confirmed an improvement after transplant. [38][39][40][41] Improved metabolic control was also associated with better health-related and diabetes-related QoL in both islet transplant alone and islet-after-kidney transplantation. 17,42 More studies are needed in the current era of modern insulin-delivery technology to compare patient-reported outcomes in pancreas versus islet transplant recipients transplanted simultaneously with or after the kidney, as well as KTA using standardized and validated surveys.…”