title: Simultaneous pancreas-kidney transplantation reduces excess mortality in type 1 diabetic patients with end-stage renal disease.
abstract: BACKGROUND
  Diabetic renal disease continues to be the most significant cause of end-stage renal disease (ESRD) in the United States. Renal transplantation improves diabetic ESRD patient survival; however, the diabetic state remains associated with poor patient survival. Simultaneous pancreas-kidney (SPK) transplantation can restore normoglycemia and thus may improve outcomes.
  
  
  METHODS
  We assessed the impact of SPK on age-range-matched type 1 diabetic patients who underwent renal transplantation at a single center. The observed/expected life span and annual mortality rates (AMRs) were used as measures of survival. A Cox proportional hazards analysis was used to analyze the impact of potential variables on mortality in SPK recipients.
  
  
  RESULTS
  SPK transplantation (N = 335) increased the observed/expected life span compared with diabetic cadaveric (DM-Cad, N = 147) and live-donor (DM-Live, N = 160) transplant recipients (P = 0.004) and significantly reduced the AMRs (SPK, 1. 5%; DM-Cad, 6.27%; DM-Live, 3.65%, P = 0.008, SPK vs. other DM). Moreover, the SPK observed/expected life span and AMR were not significantly different from that of age-range-matched nondiabetic transplant recipients (N = 492). The only variable that was significantly associated with patient survival was discharge serum creatinine (relative risk 1.16, P < or = 0.0154).
  
  
  CONCLUSIONS
  These data demonstrate that SPK improves the ability for type 1 diabetic patients to live more of their expected life span. This suggests that glycemic control, even as a late intervention in a diabetic patient's lifetime, may beneficially affect survival.
authors.affiliation: Departments of Medicine and Surgery, University of Wisconsin, Madison 53792, USA. bnb@medicine.wisc.edu
authors.forename: B N
authors.initials: BN
authors.lastname: Becker
authors.forename: P C
authors.initials: PC
authors.lastname: Brazy
authors.forename: Y T
authors.initials: YT
authors.lastname: Becker
authors.forename: J S
authors.initials: JS
authors.lastname: Odorico
authors.forename: T J
authors.initials: TJ
authors.lastname: Pintar
authors.forename: B H
authors.initials: BH
authors.lastname: Collins
authors.forename: J D
authors.initials: JD
authors.lastname: Pirsch
authors.forename: G E
authors.initials: GE
authors.lastname: Leverson
authors.forename: D M
authors.initials: DM
authors.lastname: Heisey
authors.forename: H W
authors.initials: HW
authors.lastname: Sollinger
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation