Objective: To determine the risk of competing outcomes for patients on the waitlist for Simultaneous Pancreas-Kidney (SPK) transplantation.

Design: We used the OPTN/UNOS database to examine patients (>18 y.o.) with type 1 diabetes and ESRD who were placed on the SPK waitlist from 2000-2010. Inclusion criteria were age >18 years old, listed for SPK as first listing, and receipt of any transplant. Patients listed for an SPK after a prior transplant were excluded, including those with a prior living donor kidney transplant. For multiple listings, only the first listing was counted. A competing risk analysis using STATA statistical software (version 9.2, College Station, TX) was performed between three possible outcomes: any transplant, death, and delisting. The maximum length of study was 5 years, after which time the patients were designated as “no outcome” if they remained on the list.

Results: The total number of patients meeting the inclusion criteria was 12461. Of these, 8659 received a transplant (n= 6748, 1815, 31, 22, and 43 for SPK, kidney alone, multiorgan, pancreas transplant alone, and pancreas with kidney respectively), 1262 died, 1319 were delisted, and 1221 were still on the waitlist after 5 years. According to the competing risk analysis, the cumulative incidence (percent of total cohort) of any transplant at 1, 2, 3, 4, and 5 years after initial listing was 43.4, 61.6, 68.5, 72.1, and 73.2 respectively. Mortality among patients not transplanted was 3.9, 6.9, 9.1, 10.2, and 11.0. Delisting was 3.1, 6.1, 8.4, 10.1, and 11.1.

Conclusions: In contrast to patients listed for kidney transplant, those listed for SPK are transplanted early and have low mortality on the waitlist. Mortality does not seem to increase for those who remain on the waitlist for up to 5 years.

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