Comparative Analysis of Kidney and Simultaneous Pancreas-Kidney Transplantation: Long-Term Outcomes in Type 1 Diabetic Patients with End-Stage Kidney Disease.

Background

The primary aim of pancreas transplantation in type 1 diabetic kidney transplant recipients is to reduce mortality caused by complications of progressing cardiovascular diseases and to protect kidney graft from the recurrence of diabetic nephropathy. The aim of this study was to analyze the results of the first deceased donor kidney transplantation (KTx) in patients with end-stage kidney disease caused by long-lasting type 1 diabetes (T1D), performed alone or simultaneously with the pancreas (SPK), in a long-term follow-up period.

Methods

Groups of 101 consecutive T1D patients after KTx and 93 patients after SPK performed in two transplant centers with a minimal follow-up period of 5 years were included in the analysis.

Results

Recipient, kidney graft, and death-censored kidney graft survival in a follow-up period of up to 20 years did not differ between KTx and SPK groups. In the entire observation period, total diabetes duration was shorter in the SPK group compared to KTx (28.1 ± 7.4 vs. 34.9 ± 11.0 years), and myocardial infarction (21 vs. 7%), limb amputation (12 vs. 3%), and proteinuria (40 vs. 18%) were more common in the KTx group than in SPK. The estimated glomerular filtration rate was lower in KTx recipients compared to SPK. Recipient survival was affected by the recipient's age and the duration of dialysis vintage, and kidney graft survival was affected by the duration of dialysis vintage, episodes of acute rejection, and high pretransplant sensitization in patients.

Conclusions

Despite reduced diabetes duration, a decreased frequency of cardiovascular disease complications and better kidney graft function, a simultaneously transplanted pancreas does not improve patient or kidney graft survival in T1D kidney recipients.