Renal Transplantation in Diabetic Patients with or Without Simultaneous Pancreatic Transplantation 1986: Data from the EDTA Registry

Abstract

Abstract. This report summarises the outcome of 90 combined kidney/pancreatic grafts performed in Europe in 1986. Data for the combined kidney/pancreas grafts were obtained by a special questionnaire. The one-year patient and kidney graft survival is compared to the results of a group of 389 patients with diabetic nephropathy on the EDTA Registry data file who received kidney grafts alone. The recipients of combined kidney-pancreas grafts were younger, whereas a greater proportion of males received kidney graft alone. Patient survival at one year after transplantation was similar: 89% in recipients of combined transplants compared to 90% in recipients of kidney grafts alone. Kidney graft survival was 78% at one year for recipients of combined grafts versus 76%. It is concluded that pancreas transplantation has little effect on the fate of concomitant kidney grafts. The procedure should -in Correspondence and offprint requests to: Professor F. P. Brunner, EDTA Registry, St Thomas' Hospital, London, SE1 7EH, UK. experienced hands and in selected patients -be almost as safe as kidney grafting alone.

First World Consensus Conference on pancreas transplantation: Part II – recommendations

“…The jury deliberated that SPK transplantation improves both quality of life and long‐term survival of patients with insulin‐dependent diabetes in comparison to current medical treatments and other transplant options. 33 , 34 , 37 , 38 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 These deliberations were not based on a high level of evidence and applied more strictly to patients with type 1 diabetes. In patients with type 2 diabetes, it was not clear if SPK transplant conveyed a survival advantage over live donor renal transplantation alone, while it was deemed convenient over both dialysis and deceased donor kidney transplantation.…”

“…The association between SPK transplant and improved survival in type 1 diabetic recipients was reported several times. 33 , 34 , 37 , 38 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 The acknowledgment of this advantage by an independent jury prompts the transplant community to further pursue SPK transplantation, especially when a live kidney donor is not available.…”

“…Renal grafts should be preferentially allocated to SPK recipients because of improved results with simultaneous vs. sequential transplantation, practical implications in organization of multi‐organ procurement, and a more evident survival advantage of kidney transplantation in diabetic vs. nondiabetic patients. 33 , 34 , 37 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61…”

“…The jury deliberated that SPK transplantation improves both quality of life and long‐term survival of patients with insulin‐dependent diabetes in comparison to current medical treatments and other transplant options 33,34,37,38,52–60 . These deliberations were not based on a high level of evidence and applied more strictly to patients with type 1 diabetes.…”

“…Renal grafts should be preferentially allocated to SPK recipients because of improved results with simultaneous vs. sequential transplantation, practical implications in organization of multi-organ procurement, and a more evident survival advantage of kidney transplantation in diabetic vs. nondiabetic patients. 33,34,37,[53][54][55][56][57][58][59][60][61] Preferential graft allocation to SPK could not be recommended in case of competition with highly sensitized recipients of a kidney alone transplantation with a negative crossmatch, because of lack of supporting evidence showing which transplant candidate could benefit most from that specific renal graft. 64 Similarly, there is no evidence supporting priority for kidney allocation in the event of competition between recipients of SPK Future studies should be designed taking into consideration that m-TOR inhibitors probably should not be used in the first few months after transplantation, because of the high incidence of surgical complications.…”