Comparable kidney graft survival of type 1 diabetics treated with simultaneous pancreas-kidney transplantation and nondiabetic patients treated with cadaveric renal transplantation.
Simultaneous pancreas-kidney transplantation (SPK) is now a common treatment for insulin-dependent diabetic patients with end-stage renal disease. This study analyzed the patient and graft survival rates of 231 kidney transplantations (KTX) in nondiabetic patients and of 95 SPK in diabetic patients between January 1, 1998 and December 31, 2001. The SPK group showed significantly better patient and graft survival rates after 5 years than the KTX group (96% and 90% vs 85% and 75%, respectively; P < .05). Even the serum creatinine level during the first 2 years showed significantly lower levels in the SPK group (P < .01). The patients in the SPK group were significantly younger. They received organs from younger donors than the patients in the KTX group (P < .01). The cold ischemia time and the time on previous dialysis were also shorter in the SPK group (P < .01). However, the number of HLA mismatches was higher in the SPK patients (P < .01). Limiting the analysis to recipients younger than 60 years, donors younger than 58 years, and cold ischemia time to <19 hours, there was no difference in graft or patient survival. These data suggest that donor and recipient age as well cold ischemic time have a greater impact on early outcome and postoperative complications of renal transplants than HLA matching.
Hörstrup
J H
JH
Department of Nephrology and Intensive Care Medicine, Humboldt-University, Berlin, Germany. jan.hoerstrup@charite.de
Fritsche
L
L
Neuhaus
P
P
Frei
U
U
Kahl
A
A
D002102:Cadaver; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D003929:Diabetic Neuropathies / Q000601:surgery*; D005260:Female; D006085:Graft Survival / Q000502:physiology*; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D008297:Male; D016035:Pancreas Transplantation / Q000276:immunology / Q000401:mortality / Q000502:physiology*; D012189:Retrospective Studies; D016019:Survival Analysis; D014019:Tissue Donors; D016896:Treatment Outcome