Introduction: Type 2 diabetes (T2DM) is characterized initially by insulin resistance and later by beta cell failure. Historically, T2DM has been a relative contraindication for simultaneous pancreas and kidney transplantation (SPK), as insulin resistance may render a transplanted pancreas ineffective. UNOS reports that only 9% of patients listed for pancreas transplantation have been designated as T2DM. However, recent studies of SPK have shown comparable outcomes between T2DM and Type 1 diabetes. Here we report long-term follow-up from a single center experience of SPK in T2DM.

Methods: We conducted a retrospective study of 256 patients who underwent SPK at California Pacific Medical Center from 2002 to 2015. Of these patients, 73 were categorized T2DM based on C-peptide, age of onset, insulin usage, and BMI. Outcome measures included patient/graft survival, hemoglobin A1C, BMI, lipid parameters, creatinine, and proteinuria.

Results: Patient survival was 93.2% and kidney and pancreas graft survival were 97.3% and 83.6%, respectively,with mean follow-up 6.4 years. Average hemoglobin A1C was 5.7% at one year and 5.8% at three years. Average creatinine was 1.3 mg/dL at both one and three years. BMI rose significantly from a baseline average of 27.5 kg/m² to 30.0 kg/m² at one year and 31.7 kg/m² at three years. Lipid parameters showed no significant differences. Preexisting cardiac disease defined as cardiovascular intervention was present in 28.8%, and the post-transplant incidence of cardiac events requiring intervention was 6.8%. Albuminuria occurred in 21.3% and 23.0% at one and three years, respectively, but the majority were trace on dipstick.

Conclusions: Our study reports outcome data for the largest cohort of type 2 diabetics receiving a simultaneous pancreas and kidney transplant in the literature. Patients maintained long-term euglycemia and stable renal function despite significant increases in BMI. These results suggest that T2DM should not be a contraindication to SPK and that a select group of T2DM patients could benefit from SPK transplantation.

CITATION INFORMATION: Wong K, Bry W, Mahanty H, Patel P. Simultaneous Pancreas and Kidney Transplantation for Type 2 Diabetes. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress