Introduction: Deceased donor transplantation (tx) has provided an enormous survival benefit for patients with end-stage organ failure. An analysis of the survival benefit for type 1 diabetic patients through kidney and pancreas tx has not been performed.

Purpose: To determine the survival benefit of pancreas and/or kidney txs for type 1 DM, we analyzed the UNOS/OPTN database between 10, 1987 and 6, 2015.

Methods: In this analysis, we reviewed the records of 70,755 adult type 1 diabetic patients listed for primary pancreas and/or kidney tx: 37,491 recipients who underwent a tx and 33,264 patients who were placed on the waiting list but did not undergo a tx.

We adjusted our analyses for multiple listings, incomplete classification. The primary outcome was patient death while on the waiting list or after transplant. Patient survival was computed according to Kaplan-Meier for time-to-event analysis.

Results: Waiting list mortality rates at 1- and 5-years for type 1 Kidney tx alone (KTA) recipients were 5% and 36%; for simultaneous pancreas/kidney (SPK) recipients, 5% and 49%; for solitary pancreas tx (PTA, PAK) recipients, 3% and 16% (p < 0.05). Patient survival at 10 years was 49% for DD KTA, 63% for LD KTA, 70% for SPK, 68% for PTA and 65% for a PAK after LD KTA.

We found that 187,050 life-years were saved to date during the 27 years of pancreas and/or kidney txs in type 1 diabetics. Saved life-years for KTA was 71,735 yrs; for SPK, 97,130 yrs; for PAK and PTA 18,185 yrs. This resulted in 4.98 yrs life–years that were saved for every type 1 diabetic recipient of a pancreas and/or kidney transplant. The average observed number of life-years saved for KTA recipients was 3.04 yrs; for SPK 6.24 yrs; for PAK and PTA 4.02 yrs. The difference was highly significant (p < 0.0001).

Conclusions: Our analysis demonstrates the following: (1) Waiting list mortality is significantly higher for SPK vs. KTA; (2) Pt survival is highest after SPK and PTA; (3) Only the 3rd highest pt survival rates were noted in PA LDK and LD KTA; (4) At 10-years, patient mortality rates after transplantation vs. wait list mortality for SPK patients were 30% vs 80% and for KTA patients 47% and 53% (DD only); (5) significantly more average life-years were saved with SPK and PTA/PAK than with KTA; (6) diabetic patients with kidney dysfunction benefit significantly from a simultaneous or subsequent pancreas transplant; (7) In all, pancreas and kidney transplantation in type 1 diabetics saved a total of 187,050 years.

CITATION INFORMATION: Gruessner R, Whittaker V, Ozden N, Gruessner A. The Survival Benefit of Pancreas and/or Kidney Transplantation for Patients with Type 1 Diabetes. Am J Transplant. 2016;16 (suppl 3).

« Back to 2016 American Transplant Congress