title: Delayed kidney allograft function after simultaneous pancreas-kidney transplantation.
abstract: BACKGROUND
  Simultaneous pancreas-kidney transplantation (SPKT) is one of the treatments for insulin-dependent chronic renal failure patients.
  
  
  METHODS
  One-year patient and kidney allograft survival rates of 150 patients undergoing SPKT were subjected to Cox regression and Kaplan-Meier analyses. Uni- and multivariate methods identified risk factors involved in allograft and patient survival.
  
  
  RESULTS
  One-year patient and kidney allograft survival rates were 82% and 80%, respectively. Delayed graft function (DGF) (P = .001; hazard ratio [HR]5.41) and acute kidney rejection episodes (P = .016; HR 3.36) were related to 1 year patient survival as well as intra-abdominal infection (IAI) rates. (IAI). One-year kidney allograft survival was related to DGF (P = .013; odds ratio [OR] 3.39), acute rejection (P = .001; OR 4.74), and IAI (P = .003, OR 6.29). DGF was related to a time on dialysis >27 months (P = .046; OR 2.59), cold kidney ischemia time >14 hours (P = .027; OR 2.94), donor age >25 years (P = .03; OR 2.82), and donor serum sodium concentration >155 mEq/L (P < .0001; OR 1.09). Female kidney to male recipient in 17% of the cases did not increase the risk of DGF. We observed an important correlation between donor serum sodium and creatinine (P < .0001), which suggested undertreatment of diabetes insipidus secondary to brain death.
  
  
  CONCLUSIONS
  DGF, acute rejection, and IAI were the main determinants of survival after SPKT. Improving the care of deceased donors may reduce DGF occurrence.
authors.affiliation: Division of Nephrology, Universidade Federal de São Paulo, São Paulo, Brazil. erikabr@uol.com.br
authors.forename: E B
authors.initials: EB
authors.lastname: Rangel
authors.forename: C S
authors.initials: CS
authors.lastname: Melaragno
authors.forename: A M
authors.initials: AM
authors.lastname: Gonzalez
authors.forename: M M
authors.initials: MM
authors.lastname: Linhares
authors.forename: J R
authors.initials: JR
authors.lastname: de Sá
authors.forename: A
authors.initials: A
authors.lastname: Salzedas
authors.forename: J O
authors.initials: JO
authors.lastname: Medina-Pestana
mesh_terms: D000293:Adolescent; D000328:Adult; D001938:Brazil; D016009:Chi-Square Distribution; D002648:Child; D051799:Delayed Graft Function / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D016035:Pancreas Transplantation / Q000009:adverse effects* / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult