title: Impact of simultaneous kidney-pancreas transplant and timing of transplant on kidney allograft survival.
abstract: Since 1988 over 10 000 simultaneous cadaveric pancreas-kidney transplants (SPK) have been performed in the United States among patients with end-stage renal disease due to Type 1 diabetes (T1DM). The two aims of this study were to assess the impact on kidney allograft survival of (i) SPK versus transplantation of a kidney alone (KA), and (ii) SPK prior to versus after initiation of chronic dialysis. This retrospective, non-concurrent cohort study examined registry data collected from 8323 patients waitlisted in the United States for an SPK and transplanted with either an SPK or a KA during January 1, 1990 - October 31, 2002. SPK recipients had an adjusted hazard ratio for kidney allograft loss of 0.63 (95% CI: 0.51-0.77, p < 0.001) compared to transplantation without pancreas allograft. SPK recipients who received their allografts prior to beginning chronic dialysis had a lower rate of kidney allograft loss than SPK recipients who received their transplant after initiation of chronic dialysis (adjusted hazard rates (HR) = 0.83, 95% CI: 0.69-0.99, p = 0.042). Simultaneous transplantation of pancreas-kidney compared to kidney transplantation alone and SPK prior to the initiation of chronic dialysis compared to SPK after initiation of dialysis were both associated with longer kidney allograft survival.
authors.affiliation: Renal-Electrolyte & Hypertension Division, Department of Medicine, University of Pennsylvania School of Medicine, Pennsylvania, USA. aisrani@cceb.med.upenn.edu
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
authors.forename: Harold I
authors.initials: HI
authors.lastname: Feldman
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Propert
authors.forename: Mary
authors.initials: M
authors.lastname: Leonard
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Mange
mesh_terms: D000293:Adolescent; D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D013997:Time Factors