title: The impact of pancreas transplantation on kidney allograft survival.
abstract: Whether pancreas after kidney transplantation (PAK) compromises kidney allograft survival, and what pre-PAK glomerular filtration rate (GFR) should be used to select patients for PAK is unclear. We analyzed all (n = 2776) PAK recipients in the United States between 1989 and 2007 and compared their risk of kidney failure to a comparator group of n = 13 635 young adult diabetic kidney only transplant recipients during the same time after accounting for selection bias by the use of a propensity score for PAK in a multivariate time to event analysis. In a secondary analysis, we determined the association of pre-PAK GFR with subsequent kidney allograft survival. Despite an increased risk of death early after pancreas transplantation, PAK recipients had a decreased long-term risk of kidney allograft failure compared to diabetic kidney only transplant recipients HR = 0.89; 95% CI: [0.78-1.00]; p = 0.05. An association of pre-PAK GFR with kidney survival was not evident until 3 years after pancreas transplantation, and patients with a pre-PAK GFR of 30-39 mL/min still attained 10-year post-PAK kidney survival of 69%. We conclude that PAK is associated with improved kidney allograft survival, and pre-PAK GFR 30-39 mL/min should not preclude PAK. Expanded use of PAK is warranted.
authors.affiliation: Division of Nephrology, University of British Columbia, Vancouver, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Browne
authors.forename: J
authors.initials: J
authors.lastname: Gill
authors.forename: J
authors.initials: J
authors.lastname: Dong
authors.forename: C
authors.initials: C
authors.lastname: Rose
authors.forename: O
authors.initials: O
authors.lastname: Johnston
authors.forename: P
authors.initials: P
authors.lastname: Zhang
authors.forename: D
authors.initials: D
authors.lastname: Landsberg
authors.forename: J S
authors.initials: JS
authors.lastname: Gill
mesh_terms: D005260:Female; D005919:Glomerular Filtration Rate; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D016035:Pancreas Transplantation; D012307:Risk Factors; D014481:United States