Effect of simultaneous pancreas-kidney transplantation on mortality of patients with type-1 diabetes mellitus and end-stage renal failure.
BACKGROUND
Long-term prognosis of patients with type-1 diabetes mellitus and end-stage renal failure appears to be better after kidney transplantation compared with dialysis. Controversy exists about the additional benefit of a simultaneously transplanted pancreatic graft. We studied the effect on mortality of simultaneous pancreas-kidney transplantation compared with kidney transplantation alone from regional differences in transplantation protocols.


METHODS
All 415 patients with type-1 diabetes (aged 18-52 years) who started renal-replacement therapy in the Netherlands between 1985 and 1996 were included in the analysis. Patients were allocated to a centre based on their place of residence at onset of renal failure. In the Leiden area, the primary intention to treat was with a simultaneous pancreas-kidney transplantation, whereas in the non-Leiden area, kidney transplantation alone was the predominant type of treatment. All patients were followed up to July, 1997. Analyses, mortality, and graft failure were by Cox proportional-hazard model adjusted for age and sex.


RESULTS
Simultaneous pancreas-kidney transplantation was done in 41 (73%) of 56 transplanted patients in the Leiden area compared with 59 (37%) of 158 transplanted patients in the non-Leiden area (p<0.001). The hazard ratio for mortality after the start of renal-replacement therapy was 0.53 (95% CI, 0.36-0.77, p<0.001) in the Leiden area compared with the non-Leiden area. When just the transplanted patients were analysed the mortality ratio was 0.4 (95% CI 0.20-0.77, p=0.008) and was independent of duration of dialysis and early transplant-related deaths. Equal survival was found for patients on dialysis only.


CONCLUSIONS
These data support the hypothesis that simultaneous pancreas-kidney transplantation prolongs survival in patients with diabetes and end-stage renal failure.
Smets
Y F
YF
Department of Metabolic Diseases and Endocrinology, Leiden University Medical Centre, The Netherlands. smets@xs4all.nl
Westendorp
R G
RG
van der Pijl
J W
JW
de Charro
F T
FT
Ringers
J
J
de Fijter
J W
JW
Lemkes
H H
HH
D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D016035:Pancreas Transplantation; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D017582:Renal Replacement Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome