Date: Sunday, May 3, 2015
Session Time: 2:15pm-3:45pm
Presentation Time: 2:39pm-2:51pm
Location: Room 122-AB
In simultaneous pancreas and kidney (SPK) transplantation, obesity has been reported to be associated with inferior survival and increased post-transplant complications. With implementation of the new pancreas allocation system, in type II diabetics the maximum allowable BMI for SPK listing is now 28 kg/m2. However, there are limited data on outcomes in overweight type II diabetics undergoing SPK transplantation. This may limit access to pancreas transplantation in a population that could see significant benefit. We conducted a single-institution retrospective study of 98 consecutive patients undergoing SPK transplantation from October 2007 through November 2013. Variables analyzed included recipient BMI, duration of diabetes, post-operative complications, post-transplantation insulin and oral hyperglycemic usage, as well as patient and graft survival. Of the 98 SPK transplants, 38 (38.7%) had pre-transplantation c-peptide >2ng/ml and defined as type II diabetic. Within this population, 21 (55.2%) had a BMI ≤ 28 kg/m2 (mean 25.6 kg/m2, range 19.1-27.9 kg/m2) and 17 (44.7%) had a BMI > 28 kg/m2 (Mean 28.89 kg/m2, range 28.03-29.6 kg/m2). Overall, pre-transplant variables including duration of diabetes (20.38 vs 21.42 years) and insulin utilization (0.27 vs 0.36 units/kg) were equivalent between the BMI ≤ 28 kg/m2 and BMI > 28 kg/m2 groups, respectively. Post-transplant patient survival (95% vs 100%) pancreas graft loss (10% vs 0%), and kidney graft loss (15% vs 0%) were not statistically different between the BMI ≤ 28 kg/m2 and BMI > 28 kg/m2 groups, respectively. There were no incidents of pancreas graft thrombosis or enteric leak in either group. Graft function at 1- 3- and 5-years post transplant as measured by serum creatinine (1yr: 1.5 vs 1.3 mg/dl; 3yr: 1.45 vs 1.25 mg/dl, 5yr: 1.8 vs 1.0 mg/dl), hemoglobin A1C (1yr: 5.6 vs 5.5; 3yr: 6.2 vs 5.4; 5yr: 6.3 vs 5.7) was similar comparing BMI ≤ 28 kg/m2 and BMI > 28 kg/m2, respectively. There were equally low rates of insulin (5% vs 5.8%) and oral hyperglycemic (5% vs 5.8%) in both groups. In conclusion, SPK transplantation in type II diabetics above the BMI threshold of 28 is safe, with outcomes equivalent to patients with a BMI less than 28. The new pancreas allocation policy may limit access to pancreas transplantation and therefore insulin independence in this population.
To cite this abstract in AMA style:Ahmed E, Bruce D, Carmody I, Cohen A, Loss G, Reichman T, Seal J, Bohorquez H. Is BMI of 28 an Appropriate Cutoff for Simultaneous Pancreas Kidney Transplant in Type II Diabetes? [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/is-bmi-of-28-an-appropriate-cutoff-for-simultaneous-pancreas-kidney-transplant-in-type-ii-diabetes/. Accessed November 24, 2020.
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