Study Purpose: The purpose of this study was to determine the survival benefit of pancreas and/or kidney transplants as reported over a 28-year time period (10/1987-12/2015) to the UNOS database and the Social Security Administration Death Master File for type 1 diabetic patients.

Methods: We reviewed the UNOS records of 60,826 adult type 1 diabetic patients listed for primary pancreas and/or kidney transplant (Kidney Transplant Alone [KTA], Pancreas after Kidney Transplant [PAK] , Pancreas Transplant Alone [PTA], Simultaneous Pancreas and Kidney Transplant [SPK]). Of these, 43,143 patients underwent a transplant and 17,679 patients were placed on the waiting list and did not undergo a transplant or are still on the waiting list.

We adjusted our analyses for multiple listings, incomplete diabetes classification and missing data. Primary outcome was patient survival, computed according to Kaplan-Meier.

Results: Waiting list mortality rates at 1- and 5-years for KTA recipients were 6% and 43%; for SPK recipients, 6% and 50%; for PTA & PAK recipients, 3% and 16% (p < 0.05).

Patient survival at 10-years after transplantation was as follows: for Deceased Donor [DD] KTA, 39%; Living Donor [LD] KTA, 62%; SPK, 68%; PTA, 67%; PaDDKd, 54%; PaLDKd, 65%.

We found that a total of 316,237 life-years were saved to date during the 28 years of pancreas and/or kidney transplants in type 1 diabetics. Saved life-years for DD KTA recipients was 132,254; for SPK recipients, 152,895 yrs; for PAK & PTA recipients, 31,087 yrs. This resulted in 5.12 yrs life–years that were saved for every type 1 diabetic recipient of a pancreas and/or kidney transplant. The average observed number of life-years saved for DD KTA recipients was 4.32 yrs; for SPK recipients, 6.51 yrs; for PAK & PTA recipients, 4.76 yrs. The difference was highly significant (p < 0.0001).

Conclusions: Our analysis demonstrates the following: (1) Waiting list mortality was highest for SPK and DD KTA; (2)Patient survival was highest for SPK and PTA; lowest, for DD KTA; (3) At 10-years, patient transplant vs wait-list mortality for SPK was 32% vs 82%; for DD KTA, 61% vs 84%; (4)More average life-years were saved with SPK and PTA/PAK than with DD KTA; (5)To date, primary pancreas and kidney transplants in type 1 diabetics have saved a total of 316,237 life-years.

CITATION INFORMATION: Gruessner R, Laftavi M, Pankowycz O, Whittaker V, Acun Z, Aggarwal V, Ozden N, Gruessner A. Survival Benefit of Kidney and/or Pancreas Transplantation for Patients with Type 1 Diabetes in the United States. Am J Transplant. 2017;17 (suppl 3).

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