Simultaneous Pancreas-Kidney and Pancreas Transplantation

Becker, Bryan N.; Odorico, Jon S.; Becker, Yolanda T.; Groshek, Marilyn; Werwinski, Cathy; Pirsch, John D.; Sollinger, Hans W.

doi:10.1681/asn.v12112517

Cited by 56 publications

(2 citation statements)

References 62 publications

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“…In accordance with currently available literature, we could observe that normoglycemia achieved by long-term successful SPKT in type 1 IDDM patients was associated with reduced all-cause mortality/ increased long-term patient survival compared to KTA [ 10 , 25 – 32 ].…”

Section: Discussionsupporting

confidence: 89%

Cardiovascular outcomes after simultaneous pancreas kidney transplantation compared to kidney transplantation alone: a propensity score matching analysis

et al. 2021

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Background Coronary heart disease due to arteriosclerosis is the leading cause of death in type 1 diabetic patients with end-stage renal disease (ESRD). The aim of this study was to evaluate the effect of simultaneous pancreas kidney transplantation (SPKT) compared to kidney transplantation alone (KTA) on survival, cardiovascular function and metabolic outcomes. Methods A cohort of 127 insulin-dependent diabetes mellitus (IDDM) patients with ESRD who underwent either SPKT (n = 100) or KTA (n = 27) between 1998 and 2019 at the University Hospital of Leipzig were retrospectively evaluated with regard to cardiovascular and metabolic function/outcomes as well as survival rates. An additional focus was placed on the echocardiographic assessment of systolic and diastolic cardiac function pretransplant and during follow-up. To avoid selection bias, a 2:1 propensity score matching analysis (PSM) was performed. Results After PSM, a total of 63 patients were identified; 42 patients underwent SPKT, and 21 patients received KTA. Compared with the KTA group, SPKT recipients received organs from younger donors (p < 0.05) and donor BMI was higher (p = 0.09). The risk factor-adjusted hazard ratio for mortality in SPKT recipients compared to KTA recipients was 0.63 (CI: 0.49–0.89; P < 0.05). The incidence of pretransplant cardiovascular events was higher in the KTA group (KTA: n = 10, 47% versus SPKT: n = 10, 23%; p = 0.06), but this difference was not significant. However, the occurrence of cardiovascular events in the SPKT group (n = 3, 7%) was significantly diminished after transplantation compared to that in the KTA recipients (n = 6, 28%; p = 0.02). The cardiovascular death rate was higher in KTA recipients (19%) than in SPK recipients with functioning grafts (3.3%) and comparable to that in patients with failed SPKT (16.7%) (p = 0.16). In line with pretransplant values, SPKT recipients showed significant improvements in Hb1ac values (p = 0.001), blood pressure control (p = < 0.005) and low-density lipoprotein/high-density lipoprotein (LDL/HDL) ratio (p = < 0.005) 5 years after transplantation. With regard to echocardiographic assessment, SPKT recipients showed significant improvements in left ventricular systolic parameters during follow-up. Conclusions Normoglycaemia and improvement of lipid metabolism and blood pressure control achieved by successful SPKT are associated with beneficial effects on survival, cardiovascular outcomes and systolic left ventricular cardiac function. Future studies with larger samples are needed to make predictions regarding cardiovascular events and graft survival.

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Section: Discussionsupporting

confidence: 89%

Cardiovascular outcomes after simultaneous pancreas kidney transplantation compared to kidney transplantation alone: a propensity score matching analysis

et al. 2021

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“…[3][4][5][6][7] Simultaneous pancreas-kidney transplant (SPKT) is a well-established treatment for patients with T1DM complicated by end-stage renal disease. [8][9][10][11][12][13] Despite an increase in the number of deceased donor pancreata recovered over the last decade, the overall number of pancreas transplants has continued to decline. [14,15] This is, in part, due to historically poor outcomes from pancreas transplant.…”

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confidence: 99%

Use of donors at age extremes for simultaneous pancreas-kidney transplant

Akateh

Elkhammas

Pelletier

et al. 2018

Ibnosina Journal of Medicine and Biomedical Sciences

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Type 1 diabetes mellitus (T1DM) is a major cause of morbidity and mortality in the United States and accounts for about 245 billion annual health-care costs. [1][2][3][4] There are 1.25 million Americans are living with T1DM, 85% of who are adults, with 40, 000 new diagnoses each year, and an estimated 5 million people with T1DM in the U. S. by 2050. [3][4][5][6][7] Simultaneous pancreas-kidney transplant (SPKT) is a well-established treatment for patients with T1DM complicated by end-stage renal disease. [8][9][10][11][12][13] Despite an increase in the number of deceased donor pancreata recovered over the last decade, the overall number of pancreas transplants has continued to decline. [14,15] This is, in part, due to historically poor outcomes from pancreas transplant. The recent implementation of a new pancreas allocation system, along with the proposal for a consistent definition of pancreas graft failure, as well as improving outcomes (graft and patient survival), is expected to improve the overall rates of SPKT being performed. [16,17] Unfortunately, the number of diabetic patients on the pancreas transplant waiting list continues to rise and exceeds the number of available donor organs. [16,18] This mandates different options to expand the donor pool while maintaining excellent outcome.Conventionally, pediatric donors (PDs) have been underutilized for SPKT. This was mostly driven by the lack of standard criteria for an acceptable pancreas graft. [19,20] PDs are considered by most centers to be marginal grafts due to perceived lower islet mass, higher technical demand, and potential complications. [21][22][23] Older donors (ODs) are equally also underutilized due to a perceived shorter graft survival and less optimal function. [16,24] However, there is growing evidence from single-center studies that these organs may provide comparable outcomes to standard age donors. [19,23,[25][26][27][28][29] Nevertheless, there remains a paucity of the literature to encourage the use of these donors, and as such, many centers Introduction: There is a shortage of optimal pancreatic donors for simultaneous pancreas and kidney transplant (SPKT), as such there is interest in utilizing donors at extremes of age to expand the donor pool. We sought to evaluate outcomes in SPKT from pediatric donors (PDs) to older donors (ODs). Patients and Methods: We identified patients who underwent simultaneous pancreas and kidney transplant at a single, high-volume institution from 1988-2013. We evaluated for differences in transplant organ function (estimated glomerular filtration rate [GFR], serum glucose, and urine amylase), early (technical) graft loss, and patient and graft survival. Results: A total of 729 SPKT were performed during the study, with 32 PDs, 652 standard donors (SDs), and 45 ODs. Renal function was slightly worse in OD. Otherwise, graft function was similar between all three groups at up to 5 years. There was no difference in censored survival analyses for both kidney and pancreas allografts. There was comparable sho...

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