Impact of Simultaneous Pancreas-Kidney Transplantation versus Kidney Transplant Alone on Patient and Graft Survival in Type 2 Diabetics with Elevated BMI.

S. Singh,^1,2 S. Kim.^1,2,3,4

¹Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Canada
²Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
³Division of Nephrology and the Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, Canada
⁴Division of Nephrology and the Kidney Transplant Program, St. Michael's Hospital, Toronto, Canada.

Meeting: 2016 American Transplant Congress

Abstract number: A56

Keywords: Graft survival, Kidney/pancreas transplantation, Mortality, Outcome

Background: Simultaneous Pancreas-Kidney transplantation (SPKT) is becoming increasingly common in patients with Type 2 diabetes (T2DM). The BMI threshold for listing for SPKT in this population is 28 kg/m². Recent data from a single-centre cohort of patients with T2DM has shown similar graft and patient outcomes in SPK transplant recipients with BMI >28 kg/m² vs those with BMI <28 kg/m². However, it remains unclear whether SPKT results in superior patient and graft outcomes in comparison to kidney transplant alone (KTA) in a subset of patients with a BMI > 28 kg/m².

Methods: Using the Scientific Registry of Transplant Recipients, we conducted a matched cohort study of patients with T2DM from Jan 1 2004 to Dec 31 2012. 148 SPK transplant recipients with a BMI >28 kg/m² were matched 1:5 to recipients of KTA (740 living & 740 deceased KTA recipients) based on recipient age, BMI, gender, race and transplant year. The risk of death and kidney graft failure in those with SPK vs. KTA was modeled using multivariable Cox proportional hazard models adjusted for age, BMI and wait time.

Results: Compared to deceased donor (DD) KTA, SPKT did not result in a significant improvement in patient or graft survival (aHR 0.96 [95% CI 0.56-1.65] and aHR 0.79 [95% CI 0.43-1.46]), respectively. In comparison to living donor (LD) KTA, there was no significant difference in graft survival with SPKT (aHR 0.98 [95% CI 0.51-1.86]), but there was a non-statistically significant trend towards increased mortality in SPK transplant recipients (aHR 1.59 [95% CI 0.90-2.79]).

Conclusions: The results of this study show that in patients with T2DM and elevated BMI, SPKT does not result in an improvement in patient or graft survival in comparison to DD KTA. In comparison to LD KTA, graft survival was similar and there was a non-statistically significant trend towards increased mortality with SPKT. Further study is needed to determine if SPK vs. KTA is associated with an improvement in quality of life or amelioration in the secondary complications of diabetes, which may favor SPKT despite the absence of a patient or graft survival advantage.

CITATION INFORMATION: Singh S, Kim S. Impact of Simultaneous Pancreas-Kidney Transplantation versus Kidney Transplant Alone on Patient and Graft Survival in Type 2 Diabetics with Elevated BMI. Am J Transplant. 2016;16 (suppl 3).

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