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

Abstract

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.

An analysis of the survival outcomes of simultaneous pancreas and kidney transplantation compared to live donor kidney transplantation in patients with type 1 diabetes: a UK Transplant Registry study

“…Very few studies have compared progression of diabetic complications following SPK and LDK transplantation, despite the importance of controlling for the effect of kidney transplantation alone, as some improvements may be due to restoration of normal renal function. Nevertheless, one study has compared long‐term cardiovascular mortality following SPK and LDK transplantation, adjusting for cardiovascular comorbidity, and demonstrated a significant reduction in SPK recipients . In contrast, the current study did not show any difference in cardiovascular mortality between the two transplant modalities.…”

A single-centre experience of Roux-en-Y enteric drainage for pancreas transplantation

“…Pancreas transplantation is the optimal treatment for achieving euglycaemia in selected patients with diabetes; it frees patients from the need to administer exogenous insulin, reduces metabolic instability, improves quality of life and may stabilize and reduce the long‐term effects of diabetes . The majority of potential recipients have advanced diabetic nephropathy and are candidates for simultaneous pancreas and kidney transplantation (SPK) .…”

Long‐standing diabetes mellitus and pancreas transplantation: An avenue to increase utilization of an ideal treatment modality

“…Additionally, the ability to maintain normoglycemia after the successful transplant, we believe, contributed to reduced long‐term cardiovascular mortality. Recent studies have shown that diabetic patients treated with SPK patients have lower cardiovascular mortality as compared to even living donor kidney transplant recipients . A successful pancreas transplantation is often able to slow the progression, stabilize, and even reverse many microvascular and macrovascular complications of diabetes.…”

“…at 5 years) and decreases patient mortality (relative mortality riskRR?, 0.43) . For patients with DM and end‐stage renal disease, SPK significantly improves patient survival compared to dialysis, deceased donor kidney transplantation or even living donor renal transplantation alone …”