Objective: SPK in type 2 diabetes (T2DM) is performed by a few centers in selected patients. The purpose of the study was to compare patient and graft survival of T1DM and T2DM recipients of a combined pancreas-kidney graft with T2DM recipients of a kidney transplant alone (KTA). Focus was put on demographic characteristics, cardiovascular risk factors, surgical complications and rejection rate.

Patients and Methods: Between 2000 and 2009, 196 SPK in T1DM recipients, 21 SPK in T2DM recipients and 32 KTA in T2DM recipients were performed. Patients with a positive C-peptide were considered as having T2DM. Baseline data were retrospectively collected, statistical analysis included Kaplan-Meier analysis and a Cox regression for multivariate analysis.

Results: All T2DM patients had one or more secondary complications related to their diabetes. Patient survival at one, three and five years was 96.9%, 94.2% and 91.6% for the T1DM, 90.5%, 80.1% and 80.1% for the T2DM group and 87.1%, 70.2% and 54.2% for the T2DM KTA group, respectively (P<0.001). Actuarial pancreas graft survival for SPK recipients at one, three and five years was calculated to be 92.6%, 85.8% and 80.7% for the T1DM group and 81.0%, 75.9% and 75.9% for the T2DM group, respectively, with a mean follow-up of 7.3 years. Kidney allograft survival at five years was 80.6% for T1DM, 80.4% for T2DM and 52.7 for T2DM KTA (p<0.0001). Of the 15 patients alive at last follow-up 14 did not require antidiabetic medication or exogenous insulin. In the multivariate analysis adjusting for age, gender, BMI, waiting time, CIT and DGF differences between the groups were not significant.

Conclusion: Pancreas transplantation is a therapeutic option for selected patients with T2DM. T2DM recipients are older, have higher BMI and suffer from more advanced secondary complications compared to T1DM patients. T2DM recipients of a kidney alone have an inferior graft survival compared to the other two groups.

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