title: Pancreas after living donor kidney transplants in diabetic patients: impact on long-term kidney graft function.
abstract: In this single-institution study, we compared outcomes in diabetic recipients of living donor (LD) kidney transplants that did vs. did not undergo a subsequent pancreas transplant. Of 307 diabetic recipients who underwent LD kidney transplants from January 1, 1995, through December 31, 2003, a total of 175 underwent a subsequent pancreas after kidney (PAK) transplant; 75 were deemed eligible (E) for, but did not receive (for personal or financial reasons), a PAK, and thus had a kidney transplant alone (KTA); and 57 deemed ineligible (I) for a PAK because of comorbidity also had just a KTA. We analyzed the three groups (PAK, KTA-E, KTA-I) for differences in patient characteristics, glycemic control, renal function, patient and kidney graft survival rates, and causes of death. Kidney graft survival rates (actuarial) were similar in the PAK vs. KTA-E groups at one, five, and 10 yr post-transplant: 98%, 82%, and 67% (PAK) vs. 100%, 84%, and 62% (KTA-E) (p = 0.9). The long-term (greater than four yr post-transplant) estimated glomerular filtration rate (GFR) was higher in the PAK than in the KTA-E group: 53 +/- 20 mL/min (PAK) vs. 43 +/- 16 mL/min (KTA-E) (p = 0.016). The patient survival rates were also similar for the PAK and KTA-E groups. We conclude that the subsequent transplant of a pancreas after an LD kidney transplant does not adversely affect patient or kidney graft survival rates; in fact, it is associated with better long-term kidney graft function.
authors.affiliation: Department of Surgery, Division of Renal Disease and Hypertension, University of Minnesota, Minneapolis, MN, USA. francois.kleinclauss@univ-fcomte.fr
authors.forename: Francois
authors.initials: F
authors.lastname: Kleinclauss
authors.forename: Martin
authors.initials: M
authors.lastname: Fauda
authors.forename: David E R
authors.initials: DE
authors.lastname: Sutherland
authors.forename: Colette
authors.initials: C
authors.lastname: Kleinclauss
authors.forename: Rainer W
authors.initials: RW
authors.lastname: Gruessner
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Matas
authors.forename: Bertram L
authors.initials: BL
authors.lastname: Kasiske
authors.forename: Abhinav
authors.initials: A
authors.lastname: Humar
authors.forename: Raja
authors.initials: R
authors.lastname: Kandaswamy
authors.forename: Suruchi
authors.initials: S
authors.lastname: Kaul
authors.forename: Angelika C
authors.initials: AC
authors.lastname: Gruessner
mesh_terms: D000328:Adult; D002102:Cadaver; D003928:Diabetic Nephropathies / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation; D011446:Prospective Studies; D016019:Survival Analysis; D013997:Time Factors; D009927:Tissue and Organ Procurement; D014850:Waiting Lists