December 10, 2019
2 min read
Save

Simultaneous pancreas-kidney transplant extends life expectancy better than other kidney surgeries for adults with type 1 diabetes

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

All-cause mortality risk after a simultaneous pancreas-kidney transplantation is lower than kidney transplantation alone among adults with type 1 diabetes and end-stage renal disease, according to findings published in Diabetes Care.

“We performed the present analyses to aid in the ongoing controversy of whether a simultaneous pancreas-kidney transplant as compared with a kidney transplant alone lowers mortality risk in patients with type 1 diabetes and end-stage renal failure, especially on the long term,” Kevin Esmeijer, MD, MSc, a PhD student in the department of nephrology at Leiden University Medical Center in the Netherlands, and colleagues wrote. “This is the first study that clearly shows that patients with type 1 diabetes, both 10 and 20 years after simultaneous pancreas-kidney transplant, had a substantially higher life expectancy as compared with those who received a living- or deceased-donor kidney transplant alone.”

Esmeijer and colleagues examined all-cause mortality risk in cohorts of adults with type 1 diabetes and ESRD who underwent a simultaneous pancreas-kidney transplant (n = 421; mean age, 42 years; 38% women), a transplant with a kidney from a decreased donor (n = 414; mean age, 50 years; 37% women), a transplant with a kidney from a living donor (n = 161; mean age, 48 years; 42% women) and dialysis (n = 1,800; mean age, 59 years; 47% women). Surgeries were performed and follow-up occurred from 1986 to 2016, and the Netherlands Organ Transplant Registry and Dutch Renal Registry provided patient information.

Operating room surgery 
All-cause mortality risk after a simultaneous pancreas-kidney transplantation is lower than kidney transplantation alone among adults with type 1 diabetes and end-stage renal disease.
Source: Adobe Stock

All-cause mortality risk across 10 years for participants who underwent simultaneous pancreas-kidney transplant was 33% less than the risk observed for participants who underwent a transplant with a kidney from a deceased donor (HR = 0.67; 955 CI, 0.46-0.98). All-cause mortality risk across 20 years for participants who underwent simultaneous pancreas-kidney transplant was 21% less than the risk observed for participants who underwent a transplant with a kidney from a deceased donor (HR = 0.79; 95% CI, 0.6-1.05).

Similarly, the all-cause mortality risk across 10 years for participants who underwent simultaneous pancreas-kidney transplant was 15% less than that for participants who underwent a transplant with a kidney from a living donor (HR = 0.85; 955 CI, 0.53-1.38) while the all-cause mortality risk across 20 years for participants who underwent simultaneous pancreas-kidney transplantation was 19% less than that for participants who underwent a transplant with a kidney from a living donor (HR = 0.81; 95% CI, 0.57-1.16).

PAGE BREAK

If the pancreas graft failed, all-cause mortality risk was increased across 10 years (HR = 2.15; 95% CI, 1.09-4.27) and across 20 years (HR = 1.42; 95% CI, 0.77-2.62) for participants who underwent simultaneous pancreas-kidney transplant vs. if it did not fail.

“The risk of 20-year all-cause mortality for simultaneous pancreas-kidney transplant compared with living-donor kidney recipients was 20% lower, despite the fact that living-donor kidney recipients had better kidney graft survival,” the researchers wrote.

The researchers also found that all-cause mortality risk across 10 years was decreased by 44% for participants who underwent surgery in areas where simultaneous pancreas-kidney transplant was more common vs. areas where it was less common (HR = 0.56; 95% CI, 0.4-0.78). Similarly, all-cause mortality risk across 20 years was decreased by 31% for participants who underwent surgery in areas where simultaneous pancreas-kidney transplant was more common vs. areas where it was less common (HR = 0.69; 95% CI, 0.52-0.9).

“These results encourage care providers and guidelines to adopt simultaneous pancreas-kidney transplantation as the preferred treatment option for patients with type 1 diabetes with or approaching end-stage renal disease,” the researchers wrote. – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.