Purpose: It is not known whether pancreas rejection is associated with increased kidney rejection. Also, it is not known whether pancreas survival affects kidney and patient survival in an adverse way. We hypothesized that there is concordance between kidney acute rejection episodes and pancreatic rejection episodes.

Methods. To test this hypothesis, we analysed clinical data on 155 simultaneous pancreas kidney transplants (SPK) performed between 2003 and 2014 at our institution to assess the impact of reported isolated pancreas rejection on kidney allograft outcomes. The primary outcome of interest was kidney graft rejection within one year of pancreatic rejection and kidney survival in SPK patients with and without pancreatic rejection.

Results. Mean age of patients was 45 +/- 9 yrs; 58.7% were males; 91% were caucasians. A total of 29.2% of cases had rejection (10.3% pancreatic rejection alone (PA), 6.4% had pancreas and kidney (PK) rejection, and 12.3% had kidney rejection alone(KA)). There was an overall increased incidence of kidney rejection after pancreatic rejection (p = 0.01) and progression of renal failure (manifested by the slope of rise in creatinine) was worse with PK as compared to PA (p = 0.006). Tacrolimus levels were not significantly different in all groups over a ten year period (p = 0.075). Both KA and PK adversely affected kidney survival (p = 0.012, p = 0.002) but PA did not (p = 0.616) . Any kidney rejection also adversely affected pancreas survival (p = 0.003). KA adversely affected patient survival (p = 0.047). Finally, failure of any graft had an adverse effect on the other graft and on patient survival.

Conclusions. These results indicate that there is concordance between pancreas rejection and kidney rejection. Pancreas rejection has an adverse effect on kidney survival mainly by promoting kidney rejection. In general, the failure of any organ portends a poor graft and patient outcome.

Keywords: Simultaneous pancreas kidney transplant, Acute rejection, Graft, Survival.

CITATION INFORMATION: Moinuddin I, Taber T, Yaqub M, Mishler D, Adebiyi O, Chen J, Goble M, Powelson J, Fridell J, Sharfuddin A. Concordance Between Pancreatic Rejection and Kidney Rejection and Kidney Survival in Simultaneous Pancreas Kidney Transplantation. Am J Transplant. 2016;16 (suppl 3).

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