Outcomes of Simultaneous Pancreas-Kidney vs. Kidney Alone Transplants in Type 2 Diabetic Recipients: A Multivariate Analysis of U.S. Transplants
1Medicine, University of Minnesota, Minneapolis, MN, 2Complex Care Analytics, Fairview Health Services, Minneapolis, MN, 3Surgery, University of Minnesota, Minneapolis, MN
Meeting: 2020 American Transplant Congress
Abstract number: 398
Session Information
Session Name: Pancreas and Islet: All Topics I
Session Type: Oral Abstract Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:45pm
Presentation Time: 3:27pm-3:39pm
Location: Virtual
*Purpose: The impact of simultaneous pancreas-kidney (SPK) transplants in uremic, non-obese, insulin-treated type 2 diabetic (T2DM) recipients is not well described. We analyzed the SRTR database to compare outcomes of patients and kidney grafts among three groups: SPK, deceased and living kidney transplant recipients.
*Methods: Using the SRTR standard analysis file, we identified all of the adult T2DM primary recipients who were discharged on tacrolimus and mycophenolate +/- steroids. Recipients were grouped by transplant type: SPK (n=677), deceased donor (DD) (n=22969) and living donor (LD) (n= 9211). Kaplan-Meier curves were generated to compare patients and kidney allografts survival. We analyzed the predictors of patients and kidney grafts survival utilizing Cox proportional hazard models. Centers were included as a random effect. Models were adjusted for age, sex, race, BMI, diabetes duration, PVD, years on dialysis, preemptive status, transplant type, HLA-MM, induction type, steroid maintenance, payor type, cold ischemia time, donor age.
*Results: Baseline characteristics are presented in Table 1. SPK recipients had higher overall patient survival compared to LD and DD recipients (p<0.001; Figure 1A). Death-censored kidney graft survival was the lowest in DD recipients (p<0.001; Figure 1B). In the multivariate models, as compared to LD, SPK was associated with a 29.2% higher patient survival [HR 0.718, 95% C.I. (0.58, 0.88) p=0.002], while DD was associated with a 27% higher mortality [HR 1.27, 95% C.I. (1.17, 1.37), p<0.001]. As compared to LD, both SPK [HR 1.38, 95% C.I. (1.05, 1.80), p=0.02] and DD [HR 1.41, 95% C.I. (1.24, 1.60), p<0.001] transplants had higher risk for kidney graft loss.
*Conclusions: In uremic T2DM recipients, SPK transplants were associated with survival benefit as compared to kidney alone transplants. LD kidney transplants continue to have the best kidney graft survival as compared to SPK and DD transplants. Our findings establish the value of SPK transplants in insulin dependent T2DM recipients.
To cite this abstract in AMA style:
Riad SM, Jackson S, Keys D, Humphereville V, Caramori L, Kandaswamy R. Outcomes of Simultaneous Pancreas-Kidney vs. Kidney Alone Transplants in Type 2 Diabetic Recipients: A Multivariate Analysis of U.S. Transplants [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/outcomes-of-simultaneous-pancreas-kidney-vs-kidney-alone-transplants-in-type-2-diabetic-recipients-a-multivariate-analysis-of-u-s-transplants/. Accessed May 13, 2025.« Back to 2020 American Transplant Congress