Background: PAK transplantation has been perceived as inferior to Simultaneous Pancreas and Kidney (SPK) transplantation with respect to patient and pancreas (PA) allograft survival. However, some single center studies show excellent outcomes of PAK recipients comparable to that of SPK recipients. The current analysis examines national level data to explore PAK patient and graft survival. Methods: Survival models were used to analyze OPTN data from 1995-2010 to determine if receiving a transplant was more beneficial compared to staying on the waitlist (WL). The analysis compared candidates and recipients for Pancreas Transplant Alone (PTA), PAK, and SPK procedures. Results: PAK recipients who received a PA after kidney (KI) had increased KI graft survival over 5 years compared to recipients who received a KI and no PA, regardless of living or deceased donor KI. Moreover, receiving a living donor KI was associated with increased PA graft survival over 5 years compared to receiving a deceased donor KI. Figure 1 shows the mortality after transplant vs. remaining on the WL by procedure type. A HR < 1 indicates transplanted recipients have a survival advantage. When PAK transplants are compared to recipients who received a KI transplant (2^nd panel) it appears there is no survival advantage to getting the PA transplant. However, PAK transplant recipients who receive both organs have a survival advantage compared to uremic candidates who receive neither a PA nor a KI (4^th panel). For uremic diabetic WL patients, SPK and PAK recipients showed similar overall patient survival benefits (panel 3 vs. 4). Conclusion: PAK transplants offer a survival advantage compared to those who receive neither a KI nor a PA transplant, a comparison which has not previously been made which highlights similarities in patient survival outcomes to SPK recipients and the overall benefits of uremic diabetic patients receiving both a PA and KI transplant either sequentially or simultaneously. Furthermore, these data support prior data which suggests receiving a PA transplant may have a protective effect on the KI graft.

CITATION INFORMATION: Curry M, Odorico J, Fridell J. The Benefits of Pancreas After Kidney (PAK) Transplantation. Am J Transplant. 2017;17 (suppl 3).

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