Does Dialysis Modality or Duration Influence Outcomes in Simultaneous Pancreas-Kidney Transplant Recipients?

M. Garner¹, B. Sharda², A. Farney³, J. Rogers², G. Orlando³, C. Jay⁴, A. Reeves-Daniel⁵, A. Mena-Gutierrez³, N. Sakhovskaya³, R. Stratta⁶

¹Transplant Surgery, Wake Forest Baptist Medical Center, Winston-Salem, NC, ²Wake Forest Baptist Medical Center, Winston Salem, NC, ³Wake Forest Baptist Medical Center, Winston-Salem, NC, ⁴Wake Forest Baptist Health, Winston-Salem, NC, ⁵Wake Forest University, Winston Salem, NC, ⁶Wake Forest Univ, Winston-Salem, NC

Meeting: 2022 American Transplant Congress

Abstract number: 1168

Keywords: Kidney/pancreas transplantation, Outcome, Risk factors

Topic: Clinical Science » Pancreas » 65 - Pancreas and Islet: All Topics

Session Information

Session Name: Pancreas and Islet: All Topics

Session Type: Poster Abstract

Date: Sunday, June 5, 2022

Session Time: 7:00pm-8:00pm

Presentation Time: 7:00pm-8:00pm

Location: Hynes Halls C & D

*Purpose: The influence of dialysis modality and duration on outcomes following simultaneous pancreas-kidney transplantation (SPKT) remains uncertain. The study purpose was to review our single center experience in SPKT according to pretransplant dialysis status (preemptive/no dialysis – ND, hemodialysis – HD, or peritoneal dialysis – PD) and dialysis duration (none, <2 years, 2-4 years, ≥4 years).

*Methods: From 11/01 to 8/20 (minimum follow-up one year, mean 8 years) we performed a retrospective review of 255 consecutive SPKTs. All patients (pts) received depleting antibody induction (alemtuzumab – 192, rATG – 63) with tacrolimus/mycophenolate/steroids maintenance therapy. All pts underwent SPKT with enteric drainage (216 portal-enteric, 39 systemic-enteric).

*Results: 55 patients had ND, 70 PD, and 130 were on HD at the time of SPKT. The HD group was characterized by more black pts, more pts who were C-peptide +, and longer dialysis duration (all p<0.05); all other donor, preservation, and recipient characteristics were comparable between groups. Mean waiting time for SPKT was 9 months and mean KDPI was 21%. The early (3-month) relaparotomy rate (20% ND vs 36% PD/HD, p=0.03) was lower in preemptive SPKT pts. There were no differences in rates of pancreas thrombosis (5.9%), early graft loss (8.6%), patient survival, or uncensored/censored kidney or pancreas graft survival rates (GSR) at 1 year, 5 years, or latest follow-up. We next analyzed pts according to dialysis duration (ND-55, < 2years-137, 2-4 years-41, and >4 years-n=22 [mean 72 months]). No differences were noted in rates of pancreas thrombosis or early pancreas graft loss. Early relaparotomy rates were 20% ND, 34.8% with <2 and 2-4 years of dialysis, and 45.4% in the >4 years dialysis group (p=NS). However, there were no differences in one-year patient, kidney, or pancreas GSRs. The 5-year patient survival was lower in pts on dialysis for >4 years (76.5%) compared to the other 3 groups combined (92.7%, p=0.04), but both censored and uncensored kidney and pancreas GSRs as well as patient survival were comparable at latest follow-up.

*Conclusions: In our experience, dialysis modality and duration (and preemptive transplantation) have a minimal effect on early and medium-term outcomes in SPKT pts in the setting of short waiting times, low KDPI donor organs, and dialysis duration up to 6 years.

To cite this abstract in AMA style:

Garner M, Sharda B, Farney A, Rogers J, Orlando G, Jay C, Reeves-Daniel A, Mena-Gutierrez A, Sakhovskaya N, Stratta R. Does Dialysis Modality or Duration Influence Outcomes in Simultaneous Pancreas-Kidney Transplant Recipients? [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/does-dialysis-modality-or-duration-influence-outcomes-in-simultaneous-pancreas-kidney-transplant-recipients/. Accessed May 9, 2025.

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