Do pretransplant C-peptide levels influence outcomes in simultaneous kidney-pancreas transplantation?
OBJECTIVE
To analyze outcomes in simultaneous kidney-pancreas transplantation (SKPT) recipients who retain C-peptide production at the time of SKPT.


METHODS
This retrospective analysis of SKPTs from January 2002 through January 2007 compared outcomes between patients with absent or low C-peptide levels (<2.0 ng/mL, group A) with those having levels > or =2.0 ng/mL (group B).


RESULTS
Among 74 SKPTs, 67 were in group A and seven in group B (mean C-peptide level 5.7 ng/mL). During transplantation, group B subjects were older (mean age 51 vs 41 years, P = .006); showed a later age of onset of diabetes (median 35 vs 13 years, P = .0001); weighed more (median 77 vs 66 kg, P = .24); had a greater proportion of African-Americans (57% vs 13%, P = .004); and had a longer pretransplant duration of dialysis (median 40 vs 14 months, P = .14). With similar median follow-up of 40 months, death-censored kidney (95% group A vs 100% group B, P = NS) and pancreas (87% group A vs 100% group B, P = NS) graft survival rates were similar, but patient survival (94% group A vs 71% group B, P = .03) was greater in group A. At 1-year follow-up, there were no significant differences in rejection episodes, surgical complications, infections, readmissions, hemoglobin A1C or C-peptide levels, serum creatinine, or MDRD GFR levels.


CONCLUSIONS
Diabetic patients with measurable C-peptide levels before transplant were older, overweight, more frequently African-American and had a later age of onset of diabetes, longer duration of pretransplant dialysis, and reduced patient survival compared to insulinopenic patients undergoing SKPT. The other outcomes were similar.
Singh
R P
RP
Department of General Surgery, Wake Forest University Baptist Medical Center, Winston-Salem, NC 27157, USA.
Rogers
J
J
Farney
A C
AC
Hartmann
E L
EL
Reeves-Daniel
A
A
Doares
W
W
Ashcraft
E
E
Adams
P L
PL
Stratta
R J
RJ
D000328:Adult; D017668:Age of Onset; D002096:C-Peptide / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000601:surgery; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000502:physiology*; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000276:immunology / Q000502:physiology*; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists
D002096:C-Peptide