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Twelve-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation.
- Source :
-
Clinical journal of the American Society of Nephrology : CJASN [Clin J Am Soc Nephrol] 2009 May; Vol. 4 (5), pp. 988-95. Date of Electronic Publication: 2009 Apr 30. - Publication Year :
- 2009
-
Abstract
- Background and Objectives: Simultaneous pancreas-kidney transplantation (SPK) is regarded as the treatment of choice for type 1 diabetes (T1DM) and kidney dysfunction, despite the morbidity associated with pancreas transplantation. These morbidities often influence selection of SPK versus living-donor kidney alone (LD KA) transplant. This study quantifies the impact of pancreas graft function on outcomes following SPK.<br />Design, Setting, Participants, & Measurements: Using the SRTR database, SPK wait-listed patients transplanted from 1997 to 2005 were evaluated and segregated as: (1) SPK recipients with functioning pancreas graft 12 mo posttransplant (SPK, P+); (2) SPK recipients with loss of pancreas graft function within 12 mo posttransplant (SPK, P-); (3) recipients of deceased donor (DD) KA; (4) recipients of LD KA. The study compared patient and kidney graft survival to 84 mo posttransplant.<br />Results: Patient survival for SPK, P+ was significantly better than the LD KA; SPK, P-; and DD KA cohorts (88.6% versus 80.0%, 73.9% and 64.8%, respectively [P < 0.001]), a finding confirmed by multivariate analysis and not influenced by pancreas-after-kidney transplantation (PAK) rates and outcomes. Unadjusted graft survival was also highest in the SPK, P+ cohort (72.0% versus 63.6%, 59.8%, 49.7%, P = 0.015 versus LD KA).<br />Conclusions: SPK recipients with functioning pancreas grafts have superior survival compared with LD KA and DD KA, including in the setting of PAK. Early pancreas graft failure results in kidney and patient survival rates similar to KA. These data help further clarify the decision-making of SPK versus KA transplant options for patients and providers.
- Subjects :
- Actuarial Analysis
Adult
Female
Humans
Kaplan-Meier Estimate
Kidney Transplantation mortality
Male
Multivariate Analysis
Pancreas Transplantation mortality
Registries
Risk Factors
Diabetes Mellitus, Type 1 mortality
Diabetes Mellitus, Type 1 surgery
Graft Survival
Kidney Transplantation statistics & numerical data
Pancreas Transplantation statistics & numerical data
Renal Insufficiency mortality
Renal Insufficiency surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1555-905X
- Volume :
- 4
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Clinical journal of the American Society of Nephrology : CJASN
- Publication Type :
- Academic Journal
- Accession number :
- 19406961
- Full Text :
- https://doi.org/10.2215/CJN.04940908