Pancreas after living donor kidney transplants in diabetic patients: impact on long‐term kidney graft function

Abstract

In this single-institution study, we compared outcomes in diabetic recipients of living donor (LD) kidney transplants that did vs. did not undergo a subsequent pancreas transplant. Of 307 diabetic recipients who underwent LD kidney transplants from January 1, 1995, through December 31, 2003, a total of 175 underwent a subsequent pancreas after kidney (PAK) transplant; 75 were deemed eligible (E) for, but did not receive (for personal or financial reasons), a PAK, and thus had a kidney transplant alone (KTA); and 57 deemed ineligible (I) for a PAK because of comorbidity also had just a KTA. We analyzed the three groups (PAK, KTA-E, KTA-I) for differences in patient characteristics, glycemic control, renal function, patient and kidney graft survival rates, and causes of death. Kidney graft survival rates (actuarial) were similar in the PAK vs. KTA-E groups at one, five, and 10 yr post-transplant: 98%, 82%, and 67% (PAK) vs. 100%, 84%, and 62% (KTA-E) (p = 0.9). The long-term (greater than four yr post-transplant) estimated glomerular filtration rate (GFR) was higher in the PAK than in the KTA-E group: 53 +/- 20 mL/min (PAK) vs. 43 +/- 16 mL/min (KTA-E) (p = 0.016). The patient survival rates were also similar for the PAK and KTA-E groups. We conclude that the subsequent transplant of a pancreas after an LD kidney transplant does not adversely affect patient or kidney graft survival rates; in fact, it is associated with better long-term kidney graft function.

The Impact of Method on Kidney Graft and Patient Survival in Kidney-Pancreas Transplantations for Type I Diabetes Mellitus

“…12 While Kleinclauss et al did not find any difference between LDKA and PAK patients regarding patient and kidney survival rates, they observed that HbA1c and glomerular filtration rate (GFR) to be better in PAK cases. 13 In a study by Sampaio et al on the comparison of LDKA and PAK patients, both patient survival rate (75 versus 85%) and kidney survival rate (62 versus 75%) were determined to be better in the PAK group at the end of the 8-year follow-up. 14 In this study, kidney graft survival rates in KA, SPK, and PSK groups were 86.7, 95.2, and 97.1%, and patient survival rates were 96.7, 95.2, and 100%, respectively.…”

Pancreas Versus Islets After a Successful Kidney Transplant

“…Inexorable progression of diabetes is not uncommon and further endorgan complications may truncate the ability to proceed with PAK. Patients experiencing marked decrease in cardiac reserve or showing clear evidence of aortoiliac vascular disease will likely be denied further consideration of PAK [41].…”

“…Improvement in recent outcomes in PAK and PTA through technical advances and more optimized immunosuppression mean that the comparative goalposts in pancreas and islet transplantation are constantly shifting [41,81]. Ideally, SPK provides effective therapy for both renal insufficiency and T1DM at once in a single procedure.…”

Transplantation in Diabetics with End-Stage Renal Disease

“…With increased frequency, this twostage procedure involves a living donor kidney transplantation followed by a cadaver pancreas transplant (PALK). This alternative has the advantage of a short waiting time and of a superior quality kidney graft (Kleinclauss et al, 2009). The second great advantage of PAK is performing major pancreas transplant surgery on a non-uremic patient.…”