Preemptive versus Non-preemptive simultaneous pancreas-kidney transplantation: a single-center, long-term, follow-up study.
BACKGROUND
Data regarding the timing-before or after initiation of dialysis-of simultaneous pancreas-kidney transplantation (SPKT) in type 1 diabetes mellitus patients with end-stage renal failure are sparse. We studied the effect of preemptive transplantation on patient survival, cardiovascular endpoints, and graft survival, as compared with non-preemptive transplantation.


METHODS
All 180 SPKT recipients (aged 23-58 years) who received a SPKT in Leiden between December 1986 and May 2004 were included in the analysis. Sixty-five patients (36.1%) were transplanted preemptively. Mean follow-up time was 6.3 years.


RESULTS
Up to 8.2 years after transplantation, we found no differences in patient survival. Later on, divergence occurred: 10-year patient survival was 71.3% in the preemptive group versus 63.8% in the dialysis group and 15-year patient survival was 64.8% versus 45.1% in the dialysis group, leading to an adjusted hazard ratio for mortality of 0.50 (95% CI 0.23-1.06, P=0.070). Cause of death was less often of cardiac origin in the preemptive group (adjusted HR 0.16; 95% CI 0.026-0.95, P=0.044). Graft survival did not follow the same trend. No significant differences were found between the two groups considering allograft survival, cerebrovascular accident, or myocardial infarction. The percentage of patients with minor or major amputation(s) after transplantation was slightly lower in the preemptive group (24.6 vs. 32.1%; adjusted HR 0.87; 95% CI 0.42-1.82, P=0.72).


CONCLUSIONS
Preemptive SPKT offered a patient survival benefit as compared with transplantation performed while already on dialysis and was associated with a lower rate of cardiac deaths.
Pruijm
Menno T
MT
Department of Nephrology, Leiden University Medical Center, Leiden, the Netherlands.
de Fijter
Hans J W
HJ
Doxiadis
Ilias I
II
Vandenbroucke
Jan P
JP
D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality