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Living donor kidney versus simultaneous pancreas-kidney transplant in type I diabetics: an analysis of the OPTN/UNOS database.
- Source :
-
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2009 Apr; Vol. 4 (4), pp. 845-52. Date of Electronic Publication: 2009 Feb 06. - Publication Year :
- 2009
-
Abstract
- Background and Objectives: Transplant options for type I diabetics with end-stage renal disease include simultaneous pancreas-kidney (SPKT), living donor kidney (LDKT), and deceased donor kidney transplant (DDKT). It is unclear whether SPKT offers a survival benefit over LDKT in the current era of transplantation. The authors compared outcomes of kidney transplant recipients with type I diabetes using data from the Organ Procurement and Transplant Network/United Network for Organ Sharing.<br />Design, Setting, Participants, & Measurements: Adult (age 20 to 59) type I diabetics who received a solitary first-time kidney transplant between 2000 and 2007 were studied. Outcomes included overall kidney graft and patient survival. Multivariate analysis was performed using a stepwise Cox proportional hazards model.<br />Results: Kidney graft survival was better for recipients of LDKT compared with SPKT (P = 0.008), although patient survival was similar (P = 0.346). On multivariate analysis, LDKT was associated with lower adjusted risks over 72 mo follow-up of kidney graft failure (HR 0.71; 95% CI 0.61 to 0.83) and patient death (HR 0.78; 95% CI 0.65 to 0.94) versus SPKT. Compared with DDKT, SPKT had superior unadjusted kidney graft and patient survival, partly due to favorable SPKT donor and recipient factors.<br />Conclusions: Despite more transplants from older donors and among older recipients, LDKT was associated with superior outcomes compared with SPKT and was coupled with the least wait time and dialysis exposure. LDKT utilization should be considered in all type I diabetics with an available living donor, particularly given the challenges of ongoing organ shortage.
- Subjects :
- Adolescent
Adult
Databases as Topic
Diabetes Mellitus, Type 1 complications
Diabetes Mellitus, Type 1 mortality
Diabetic Nephropathies etiology
Diabetic Nephropathies mortality
Donor Selection
Female
Graft Survival
Humans
Kidney Failure, Chronic etiology
Kidney Failure, Chronic mortality
Male
Middle Aged
Patient Selection
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Time Factors
Tissue and Organ Procurement statistics & numerical data
Treatment Outcome
United States epidemiology
Waiting Lists
Young Adult
Diabetes Mellitus, Type 1 surgery
Diabetic Nephropathies surgery
Kidney Failure, Chronic surgery
Kidney Transplantation adverse effects
Kidney Transplantation mortality
Living Donors
Pancreas Transplantation adverse effects
Pancreas Transplantation mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1555-905X
- Volume :
- 4
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Publication Type :
- Academic Journal
- Accession number :
- 19201918
- Full Text :
- https://doi.org/10.2215/CJN.02250508