We examined associations of insulin use after pancreas transplant with patient survival, and with kidney graft survival among simultaneous kidney-pancreas transplant (SKPT) recipients, in a national US cohort. We also compared agreement of insulin use and center-reported pancreas failure.

Study data were constructed linking SRTR registry identifiers to records from a large pharmaceutical claims warehouse for 3941 SPKT and 1294 pancreas alone transplant (PAT) recipients (2008-2015).

Associations (adjusted hazard ratio, 95% _LCL aHR 95%_UCL) of post-transplant insulin fills with death and graft failure were quantified by time-varying Cox regression, with adjustment for baseline recipient, donor and transplant factors. Pancreas graft failure reports were compared across levels of insulin fills in yr 1, 2 and 3 after transplant.

By 1yr and 3yr post-transplant, the cumulative incidence of insulin fills was 13.5% and 19.9% among SPKT recipients, and 19.9% & 31.7% among PAT recipients, respectively. Compared to no insulin requirement, insulin fills after transplant predicted 3-times the risk of subsequent death (_1.543.03_5.98) among SPKT recipients, and 4-times the risk of subsequent death (_1.584.31_11.78) among PAT recipients. Insulin fills were also associated the 3-times the risk of kidney graft failure after SPKT (_2.823.39_4.08).

Higher post-transplant insulin requirement bore graded associations with pancreas allograft failure reporting among PAT recipients. However, for a given insulin requirement, pancreas failure reporting was lower among SPKT than PAT recipients. ~22% to 25% to those with highest insulin use in the first year did not have reported pancreas graft failure.

The need for prescription insulin after SPKT and PAT predicts subsequent death and kidney graft loss. Center reporting of insulin use as pancreas failure has been inconsistent.

CITATION INFORMATION: Ouseph R., Lentine K., Zhang Z., Axelrod D., Randall H., Kasiske B., Israni A., Dharnidharka V., Alhamad T., Brennan D., Segev D., Hess G., Schnitzler M. Insulin Use after Pancreas Transplant: Implications for Post-Transplant Outcomes Am J Transplant. 2017;17 (suppl 3).

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