Three-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation in type 2 diabetes patients

Abstract

Successful simultaneous pancreas‐kidney transplantation (SPK) improves quality‐of‐life and prolongs kidney allograft and patient survival in type‐1 diabetic (T1DM) patients. However, the use of SPK in type‐2 diabetic (T2DM) patients remains limited. We examined a national transplant registry for 35 849 T2DM kidney disease patients who received transplant between 2000 and 2016 and survived the first 3 months with a functioning kidney, and categorized as: deceased‐donor kidney transplant alone (DD‐KA, 68%), living‐donor kidney transplant alone (LD‐KA, 30%), or SPK (2%). Among SPK recipients, 6% had pancreas allograft failure within 3 months (SPK,P‐) and 94% had a functional pancreas (SPK,P+). Associations of transplant type with kidney allograft failure and death (multivariable‐adjusted hazard ratio, 95%LCLaHR95%UCL), over follow‐up through December 2018, were quantified by multivariable inverse probability of treatment weighted survival analyses. SPK recipients had better kidney graft and patient survival than LD‐KA or DD‐KA recipients. Compared to SPK,P+, DD‐KA, or LD‐KA recipients had significantly higher risk of kidney allograft failure (DD‐KA: aHR 1.532.203.17; LD‐KA: aHR 1.291.872.71) and death (DD‐KA: aHR 2.123.255.00; LD‐KA: aHR 1.542.353.59). SPK,P‐ recipients had significantly higher risk of death (aHR 1.683.306.50). Similar to T1DM, T2DM patients with SPK have a survival benefit compared to those with kidney transplant alone, but this benefit depends upon successful early pancreas function.

Preoperative C-Peptide Predicts Weight Gain After Pancreas Transplantation

“…In these carefully selected recipients, pancreas graft and patient survival approaches requisite benchmarks. 4,5,8,9 Analysis of the Organ Procurment Transplant Network/ United Network for Organ Sharging (OPTN/UNOS) database comparing pancreas transplants in insulinopenic or type 2 diabetic recipients demonstrated no difference in patient or graft survival in carefully selected patients. 2,10,11 Furthermore, the Scientific Registry of Transplant Recipients database analysis showed that combined pancreas and kidney transplantation afforded better survival compared to kidney transplant alone in type 2 diabetes, but univariate analysis identify donor and recipient age (and not the pancreas graft) as imparting survival advantage.…”

“…2,10,11 Furthermore, the Scientific Registry of Transplant Recipients database analysis showed that combined pancreas and kidney transplantation afforded better survival compared to kidney transplant alone in type 2 diabetes, but univariate analysis identify donor and recipient age (and not the pancreas graft) as imparting survival advantage. 9 Notwithstanding these conflicting studies, euglycemia as measured by the normalization of hemoglobin A 1c (HbA 1c ) occurs after pancreas transplantation regardless of diabetes type. Given sustained glucose regulation, the pancreas allograft likely abrogates the progression of many secondary complications of diabetes.…”

Impact of Functional Status on Outcomes of Simultaneous Pancreas-kidney Transplantation: Risks and Opportunities for Patient Benefit

“…Missing covariate status was included as a regression parameter, as per our standard analytic approach. 27 - 31 The clinical characteristics of patients with lower than normal functional status (caring for self, requiring assistance, or disability) were compared with patients with normal functional status using the Chi-squared test.…”

Abdominal Organ Transplantation: Noteworthy Literature in 2019

“…Alhamad et al studied the national transplant registry of 35 849 T2DM patients with end-stage renal disease (ESRD) with or without renal replacement therapy who received transplants between 2000 and 2016. 5 They divided recipients into 3 subgroups for analysis: DDKT alone (68%), LDKT (30%), or SPK (2%). Although SPK made up the smallest percentage, 94% had a functional pancreas at 3 months.…”