Characteristics and early outcomes of patients referred for simultaneous pancreas/kidney transplantation (SPKT) to a national pancreas transplant unit.

Background: SPKT in Australia uses recipient criteria that are highly selective compared to those internationally, including a conservative recipient upper-age limit. Mortality rates due to comorbidity are high, therefore early referral is encouraged (eGFR <=25ml/min) to allow early identification of issues precluding transplantation. Aim(s): To describe the characteristics and early outcomes of patients referred to our unit for SPKT. Method(s): All referrals to our centre from 1/6/2010-30/6/2018 were reviewed. Patient characteristics including age, dialysis status, eGFR, and geographic origin were examined. Early outcomes (within 6 months after first initial assessment) were assessed including death, in principle acceptance/non-acceptance, and presence of clinical issues precluding transplantation. Result(s): During the study period, 290 referrals were received (48% females, mean age 40.3yrs (SD +/- 8.1)) with 240 (83%) referred from other centres. States referring were VIC 76.9%, SA 14.8%, TAS 7%, NSW/QLD/NT 1.3%. After excluding pancreas without kidney referrals, 75/279 (27%) were already on dialysis at referral. For those pre-dialysis (73%) mean eGFR was 21ml/min (SD +/-8). Of the 260 patients who attended the initial review, 16% were deemed unsuitable while 209 (80%) were accepted in principle. The remaining 4% had an acceptance decision deferred. Median time from referral to appointment was 95 days (range 67- 140). Seven (2.4%) died prior to review or soon after initial assessment (mean age 40.3, SD +/- 5.5 years). Sixty-six (32%) had clinical issues precluding transplantation (eg. heart disease, smoking, overweight, psychosocial issues). Conclusion(s): Patients referred for SPK transplantation to our centre are generally young and have a high mortality rate. A significant proportion are referred late, having already commenced dialysis. Many have complex clinical issues needing resolution before they can progress to transplantation.