Background: Many prior SPK patients present for a second kidney allograft. Prior studies have addressed the technical challenges to re-transplantation in this population, but there is a paucity of data on the outcomes of SPK patients who undergo kidney re-transplantation.

Objective: The goal of the current study was to determine if SPK patients who have a functioning pancreas graft have improved graft and patient survival after kidney re-transplantation.

Methods: We analyzed the SRTR database of SPK transplants performed October 1987- May 2012, identifying 3 groups of SPK recipients who received a second kidney transplant: 1) patients with a functioning pancreas allograft, 2) patients with a failed pancreas allograft, and 3) patients who underwent re-SPK. We performed competing risk survival analyses to determine the impact of a functioning pancreas allograft on kidney graft and patient survival after kidney re-transplantation.

Results: 18,695 SPK transplants were identified. A total of 1,667 patients received a second kidney transplant: Group 1 with a functioning pancreas allograft (N=1,167), Group 2 with a failed pancreas allograft (N=344), and Group 3 undergoing re-SPK (N=156). Among patients receiving a repeat kidney transplant alone, Group 1 had better patient survival (p < 0.002) and marginally better kidney graft survival (p = 0.07) than Group 2. Among patients with non-functioning pancreases at the time of kidney retransplantation, Group 3 had equivalent patient survival (p = 0.8) but poorer kidney graft survival rates than Group 2 (p = 0.03).

Conclusions: The presence of a functioning pancreas allograft is associated with improved kidney graft and patient survival for SPK patients undergoing kidney re-transplantation, consistent with a biological benefit of pancreas endocrine function. The results of this study also demonstrate that re-SPK is associated with a significantly increased risk of kidney graft loss compared to kidney re-transplantation alone, with no benefit in patient survival, calling into question whether re-SPK should be offered to patients.

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