Despite rapid medical advancements in the field of transplantation, mean allograft survival remained at a standstill. If and to what extent a highly specialized and experienced aftercare of simultaneous pancreas-kidney transplant recipients (SPKTRs) impacts patient and allograft outcomes, however, remains mostly unknown. We hypothesized that transplant-center provided aftercare of SPKTRs ultimately improves patient, pancreas and kidney allograft survival.

We retrospectively analyzed 210 SPKTRs transplanted between 1998 and 2015 with respect to patient, pancreas and kidney allograft survival. SPKTRs treated regularly in our transplant center in long-term follow-up were compared with SPKTRs followed by local nephrologists. SPKTRs that make no use of the transplant center provided aftercare, were assessed by a questionnaire-based survey with respect to allograft survival and their reasons not to make use of it.

In total 138 SPKTRs (65.7%) were followed in our transplant center and 72 SPKTRs (34.3%) were followed by local nephrologists. Shorter distance to the transplant center was identified as the only independent factor associated with strong adherence to the transplant center provided aftercare (p<0.001). Using cox regression with the last visit in the transplant center as the time-dependent covariate showed a significantly better patient survival [HR: 6.73 (95% CI: 3.08-14.72; p=0.001)], pancreas allograft survival [HR: 4.68 (95% CI: 2.14-10.24; p=0.001)], and kidney allograft survival [HR: 3.54 (95% CI: 1.24-10.11; p=0.018)] among SPKTRs followed by the transplant center compared to SPKTRs followed by local nephrologists only. Reasons not to make use of the transplant center provided aftercare included distance (53%), prohibitively expensive costs (42%) and no identifiable advantages (28%).

Our data strongly indicate that provision of aftercare by the transplant center is highly associated with superior patient, pancreas and kidney allograft survival. The observed wide differences may be attributed to highly specialized immunological and infectious screening protocols, careful and critical guidance of immunosuppression, and more comprehensive medical care.

CITATION INFORMATION: Schachtner T., Zaks M., Kahl A., Reinke P. Provision of Highly Specialized Aftercare by the Transplant Center Strongly Improves Patient, Pancreas and Kidney Allograft Survival in Long-Term Follow-Up after Simultaneous Pancreas-Kidney Transplantation Am J Transplant. 2017;17 (suppl 3).

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