Introduction: In SPK transplants, the major risk factors for poor patient survival are early pancreas and/or kidney graft loss. In this study, we specifically examined the impact of early pancreas graft loss (≤ 90 days post-transplant) on the simultaneously transplanted kidney graft and on patient survival.

Methods: From 1/1/2010 to 12/31/2015 information on 4,422 US primary deceased donor SPK transplants was reported to UNOS and the International Pancreas Transplant Registry (IPTR). The pancreas graft only failed within the first 90 days post-transplant in 242 (5.5%) cases; the kidney graft only, in 30 (0.7%) cases; both grafts, in 64 (1.5%) cases. Comprehensive analyses were performed to describe the risk of early pancreas graft failure and its subsequent impact on the simultaneously transplanted kidney graft.

Results: At 3-month post-transplant, SPK patient, kidney, and pancreas graft survival rates were 98.8%, 97.8% and 92.9%, respectively. In 45 (70%) of the 64 cases with both organ failures, both grafts failed at the same time and 'dying with functioning grafts' was noted in 38 (85%) of the 45 cases. Only 3 kidney grafts failed before the pancreas graft failed, too.

The major reasons for early pancreas graft failure in the 242 cases with pancreas graft failure only (and with a remaining functioning kidney graft) were technical in 88% and immunologic in 5%. The major risk factors for early pancreas failure were older donor age, long preservation time (>12 hrs), no induction therapy, maintenance therapy without tacrolimus and MMF, and recipient obesity.

One-year patient survival after early pancreas graft loss but with remaining kidney function was 97.6%. After pancreas graft failure, kidney graft loss was 2.5% at 1 month and only 4.3% at 1 year. The cause of pancreas graft failure had no impact on patient survival or kidney graft function.

Summary: The impact of early pancreas graft loss on the simultaneously transplanted kidney is minimal. Technical complications remain the most common reason for early pancreas graft loss. However, technical complications can be significantly reduced with careful recipient and donor selection (young donor age, short preservation times, use of induction therapy and maintenance therapy with tacrolimus and MFF). In conclusion, early pancreas graft failure has no longer a deleterious effect on patient survival or on the simultaneously transplanted kidney.

CITATION INFORMATION: Gruessner A, Laftavi M, Whittaker V, Acun Z, Pankowycz O, Gruessner R. Impact of Early Pancreas Graft Failure on Patient and Kidney Graft Survival After Simultaneous Pancreas and Kidney Transplantation (SPK). Am J Transplant. 2017;17 (suppl 3).

« Back to 2017 American Transplant Congress