Kidney Allograft and Patient Survival in Type I Diabetic Recipients of Cadaveric Kidney Alone Versus Simultaneous Pancreas/Kidney Transplants

Abstract

Abstract. Simultaneous pancreas-kidney transplant (SPK) is now a common treatment for insulin-dependent diabetic patients with end-stage renal disease. Renal graft survival rates after SPK have been less well studied. This study compared the kidney survival results for 3642 SPK and 2374 cadaveric renal transplants (CRT) in type I diabetic patients at 112 US transplant centers reported to UNOS during 1994 through 1997. The analysis included follow-up information through September 2000. The kidney graft survival rates were significantly lower among recipients of CRT compared with SPK recipients (P Ͻ 0.001). Patients who received SPK were younger, less often sensitized, transplanted after shorter periods on dialysis, and less often black. The donors of SPK organs were younger, more often died from head trauma, were less often female, and more often black. SPK renal grafts were transplanted with a shorter cold ischemia time to more poorly HLA-matched recipients. After adjustment of these and other factors, whether a patient was recipient of CRT or SPK was not associated with increased risk of kidney graft failure or patient death. SPK recipients experienced half the rate of delayed kidney function (11% versus 23%) but nearly double the rate of rejections during the initial hospitalization (15% versus 9%) compared with CRT recipients. SPK was associated with better renal allograft survival compared with CRT, despite a higher rate of renal allograft rejection. This observation was explained by favorable donor and recipient factors in the SPK group. After controlling for these factors, SPK provided no protective or detrimental effect on short-term renal allograft or patient survival. bunnapradist@cshs.org

Natural History of Kidney Graft Survival, Hypertrophy, and Vascular Function in End-Stage Renal Disease Type 1 Diabetic Kidney-Transplanted Patients

“…The presence of an altered RI suggests a reduction of the intrarenal vascular surface and probably the appearance of glomerulosclerosis (5)(6)(7)(8). It is likely that abnormalities in RI and UAE appear earlier in the transplant kidney than in the diabetic patient's own kidney due to the "sensitizing" effect of calcineurin inhibitors on glomeruli.…”

“…Glomerular hyperfiltration is the first feature of renal involvement and can be observed soon after diabetes onset, accompanied by a loss of renal functional reserve (3). Microalbuminuria appears later, as do morphological changes such as thickening of the glomerular basement membrane and mesangial expansion (4).Nephrosclerosis or glomerulosclerosis of the transplanted kidney in end-stage renal disease (ESRD) type 1 diabetic kidney transplant patients may result from the interaction of diabetes, hypertension, obesity, smoking, and dyslipidemia and from nephrotoxicity of certain immunosuppressive drugs (calcineurin inhibitors but not only) (5-6), leading to a reduction in the intrarenal vascular surface area and an increase in vascular resistance (7-10).Pancreas and islet transplantation can confer insulin independence in type 1 diabetic transplant patients, thus preventing the progression to diabetic nephropathy, improving graft survival, and ameliorating diabetic macro-/microangiopathy (6,(11)(12)(13)(14)(15)(16)(17). It is likely that islet transplant could ameliorate renal function through improved glycometabolic control and restoration of C-peptide secretion (14,18 -23).…”

“…Pancreas and islet transplantation can confer insulin independence in type 1 diabetic transplant patients, thus preventing the progression to diabetic nephropathy, improving graft survival, and ameliorating diabetic macro-/microangiopathy (6,(11)(12)(13)(14)(15)(16)(17). It is likely that islet transplant could ameliorate renal function through improved glycometabolic control and restoration of C-peptide secretion (14,18 -23).…”

Kidney Graft and Patient Survival With and Without a Simultaneous Pancreas Utilizing Contralateral Kidneys From the Same Donor

“…Previous studies comparing survival rates between SPK and KA recipients showed conflicting results (5)(6)(7)(8)(9)(10)(11). In some studies, more favorable donors were used for SPK and healthier recipients received SPKs (5,7,8,11).…”

“…In some studies, more favorable donors were used for SPK and healthier recipients received SPKs (5,7,8,11). These studies relied on the multivariate analyses to adjust for recipient, donor, and transplant variables.…”