Living Donor Kidney Versus Simultaneous Pancreas-Kidney Transplant in Type I Diabetics

Young, Brian; Gill, Jagbir; Huang, Edmund; Takemoto, Steven K.; Anastasi, Bishoy; Shah, Tariq; Bunnapradist, Suphamai

doi:10.2215/cjn.02250508

Cited by 94 publications

(79 citation statements)

References 32 publications

(31 reference statements)

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“…This view is further supported by the fact that the major cause of death in all these patients is primarily cardiovascular disease (62%), followed by infection (16%), malignancy (8%), and other causes (14%). 6 It also potentially explained why in Young et al's study, 4 despite initial superior patient survival following LDKA compared with SPK (1-year survival of LDKA, SPK, and DDKA was 97%, 95%, and 93%, respectively), the results began to favour SPK by the end of the 72-month study period.…”

Section: Patient Survivalmentioning

confidence: 97%

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

et al. 2016

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Objectives: To review the outcome following simultaneous pancreas and kidney transplantation in patients with type 1 diabetes mellitus and endstage renal disease, as well as those with type 2 diabetes mellitus, and to discuss the applicability of this treatment in this locality. Methods:A systematic literature review was performed by searching the PubMed and Elsevier databases. The search terms used were "simultaneous pancreas and kidney transplantation", "diabetes", "pancreas transplant" and "SPK". Original and major review articles related to simultaneous pancreas and kidney transplantation were reviewed. Papers published in English after 1985 were included. Clinical outcomes following transplantation were extracted for comparison between different treatment methods. Outcomes of simultaneous pancreas and kidney transplant and other transplantation methods were identified and categorised into patient survival, graft survival, diabetic complications, and quality of life. Patient survivals and graft survivals were also compared. Results

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Section: Patient Survivalmentioning

confidence: 97%

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

et al. 2016

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“…The obvious benefit of a functioning pancreas graft is normalised blood glucose control without the use of insulin, compared with consistent moderate hyperglycaemia controlled with insulin use. The question whether cardiovascular outcomes can be improved by transplanting a pancreas simultaneously with the kidney remains, however, controversial [11][12][13][14]. A major obstacle when comparing outcomes following SPK vs kidney transplantation alone (KTA; from either a deceased or a living donor) in recipients with type 1 diabetes has been imbalance in risk factors between patient populations, particularly due to selection of younger patients with less comorbidity for SPK transplantation.…”

Section: Introductionmentioning

confidence: 99%

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

et al. 2015

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Aims/hypothesis Mortality due to cardiovascular disease (CVD), particularly coronary artery disease (CAD), is high in type 1 diabetic patients with end-stage renal disease (ESRD). We aimed to determine whether normoglycaemia, as achieved by successful simultaneous pancreas and kidney (SPK) transplantation, could improve long-term outcomes compared with living donor kidney-alone (LDK) transplantation. Methods We studied 486 type 1 diabetic patients with ESRD who underwent a first SPK (n = 256) or LDK (n = 230) transplant between 1983 and 2012 and were followed to the end of 2014. Data were retrieved from the Norwegian Renal Registry and hospital records. Kaplan-Meier plots and multivariate Cox regression, with correction for recipient, donor and transplant factors, were used to examine potential associations between transplant type and all-cause and CVD-and CADrelated mortality. Results Median follow-up time was 7.9 years (interquartile range 4.3, 12.9). The adjusted HR for CVD-related deaths in SPK recipients compared with LDK recipients was 0.63 (95% CI 0.40, 0.99; p = 0.047), while the HRs for all-cause and CAD-related mortality were 0.81 (95% CI 0.57, 1.16; p = 0.25) and 0.63 (95% CI 0.36, 1.12; p = 0.12), respectively. Compared with the LDK group, SPK recipients were younger and received grafts from younger donors. Cardiovascular mortality was higher in patients transplanted between 1983 and 1999 compared with those who received their grafts in subsequent years. Conclusions/interpretation In patients with type 1 diabetes and ESRD, SPK transplantation was associated with reduced long-term cardiovascular mortality compared with LDK transplantation.

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“…Compared with kidney transplant alone, a successful SPK may improve quality of life (2,3), diminish the progression of diabetic complications (4,5), and possibly prolong patient and kidney allograft survival (6 -9). In T1DM, SPK transplant outcomes are excellent, with a reported 5-year patient, kidney, and pancreas graft survival of 88%, 77% (10), and 69% (11), respectively.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Simultaneous Pancreas-Kidney Transplantation in Type 2 Diabetic Recipients

Sampaio

Kuo

Bunnapradist

2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Type 2 diabetic patients with end-stage renal disease may receive a simultaneous pancreas-kidney (SPK) transplant. However, outcomes are not well described. Risks for death and graft failure were examined in SPK type 2 diabetic recipients.Design, setting, participants, & measurements Using the United Network for Organ Sharing database, outcomes of SPK transplants were compared between type 2 and type 1 diabetic recipients. All primary SPK adult recipients transplanted between 2000 and 2007 (n ϭ 6756) were stratified according to end-stage pancreas disease diagnosis (type 1: nϭ6141, type 2: nϭ582). Posttransplant complications and risks for death and kidney/pancreas graft failure were compared. ResultsOf the 6756 SPK transplants, 8.6% were performed in recipients with a type 2 diabetes diagnosis. Rates of delayed kidney graft function and primary kidney nonfunction were higher in the type 2 diabetics. Five-year overall and death-censored kidney graft survival were inferior in type 2 diabetics. After adjustment for other risk factors, including recipient (age, race, body weight, dialysis time, and cardiovascular comorbidities), donor, and transplant immune characteristics, type 2 diabetes was not associated with increased risk for death or kidney or pancreas failure when compared with type 1 diabetic recipients. ConclusionsAfter adjustment for other risk factors, SPK recipients with type 2 diabetes diagnosis were not at increased risk for death, kidney failure, or pancreas failure when compared with recipients with type 1 diabetes.

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Living Donor Kidney Versus Simultaneous Pancreas-Kidney Transplant in Type I Diabetics

Cited by 94 publications

References 32 publications

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease

Long-term cardiovascular outcomes in type 1 diabetic patients after simultaneous pancreas and kidney transplantation compared with living donor kidney transplantation

Outcomes of Simultaneous Pancreas-Kidney Transplantation in Type 2 Diabetic Recipients

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