Long-term survival after kidney and kidney-pancreas transplantation in diabetic patients.
OBJECTIVE
To investigate the influence of diabetes mellitus on patient and graft survival among renal versus renal-pancreatic recipients.


METHODS
Among 270 renal transplants performed from 1985 to 2002, a total of 204 (75%) were in diabetic patients and 66 (25%) in nondiabetic patients. Among the 204 diabetic patients 161 (60%) kidneys were transplanted simultaneously with a pancreatic graft (SKPT group). The overall group of patient included 164 (61%) men and 106 (39%) women with mean time on dialysis of 31 +/- 21 months (range 0 to 126 months). The mean duration of diabetes was 24 +/- 7 years (range 5 to 51 years). Ninety-nine percent of the patients were on renal replacement therapy (79% hemodialysis and 20% peritoneal dialysis).


RESULTS
The overall rejection rate was similar (NS). Both patient and kidney graft survival rates were worse in diabetics. Patient survival was 82% at 5 years among patients undergoing SKPT, 60% in diabetics receiving only a kidney, and 88% in nondiabetic transplanted patients. Kidney graft survival at 5 years was 77% in diabetics receiving SKPT, 68% in diabetics receiving a kidney alone, and 82% in nondiabetic patients. Overall patient survival was significantly greater among nondiabetics (P =.002) or in diabetics who received SKPT compared with diabetics who only had a kidney transplant (P =.001).


CONCLUSIONS
This retrospective clinical evaluation confirms that combined pancreas and kidney transplantation should be the first choice to insulin-dependent diabetes mellitus (IDDM) patients with end-stage diabetic nephropathy.
Orsenigo
E
E
Department of Surgery, Vita e Salute University, San Raffaele Scientific Institute, Milan, Italy. elenaors@libero.it
Fiorina
P
P
Cristallo
M
M
Socci
C
C
La Rocca
E
E
Maffi
P
P
Invernizzi
L
L
Zuber
V
V
Secchi
A
A
Di Carlo
V
V
D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000453:epidemiology / Q000401:mortality; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D017211:Treatment Failure