title: Does simultaneously transplanted pancreas improve long-term outcome of kidney transplantation in type 1 diabetic recipients?
abstract: BACKGROUND
  Simultaneous pancreas-kidney transplantation (SPK) is an alternative to kidney transplantation (KTx) for type 1 diabetic patients with end-stage kidney disease. However, a fair comparison of SPK and KTx is difficult because of significant differences in donor, recipient, and transplantation procedure parameters. The aim of this study was to compare the early and long-term outcomes of SPK versus KTx in southwest Poland.
  
  
  METHODS
  Thirty-five diabetic dialysis patients who had SPK and 64 patients who had KTx were included in the analysis.
  
  
  RESULTS
  SPK recipients were younger (38±6 years versus 42±9 years) and received organs from younger donors (25±7 versus 43±12 years) compared to the KTx group. They had shorter kidney cold ischemia time (9±2 hours versus 22±7 hours) but worse HLA class II mismatches (1.4±0.6 versus 1.0±0.5). In the early postoperative period, three patients died from the SPK group and one patient died from the KTx group. Additionally, two SPK patients lost their pancreatic grafts, and five KTx patients lost their kidney grafts. One-year patient survival rates for the SPK and KTx groups were 88% and 98%, respectively, and 5-year, 81% and 93%, respectively. One-year kidney graft survivals rates for the SPK and KTx groups were 100% and 89%, respectively, and 5-years, 89% and 81%, respectively. One-year insulin-free survival among SPK patients was 90% and the 5-year survival rate was 76%. Excretory function of the transplanted kidneys was better among SPK group; however, the difference reached statistical significance only in posttransplant years 2 and 3: 63.5±20.1 versus 50.3±19.7 and 64.9±12.9 versus 51.6±21.8 mL/min/1.73 m2 for SPK and KTx, respectively.
  
  
  CONCLUSIONS
  Normoglycemia in SPK recipients did not improve patient survival at 5 years. The worse HLA compatibility in the SPK group did not lead to impaired kidney graft survival compared to KTx. Better kidney graft function among SPK recipients probably resulted from a more restrictive donor selection.
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland. ziacek@mp.pl
authors: J
authors: J
authors: Ziaja
authors: J
authors: J
authors: Chudek
authors: A
authors: A
authors: Kolonko
authors: D
authors: D
authors: Kamińska
authors: A
authors: A
authors: Kujawa-Szewieczek
authors: M
authors: M
authors: Kuriata-Kordek
authors: R
authors: R
authors: Król
authors: M
authors: M
authors: Klinger
authors: A
authors: A
authors: Wiecek
authors: D
authors: D
authors: Patrzałek
authors: L
authors: L
authors: Cierpka
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods* / Q000401:mortality; D011044:Poland / Q000453:epidemiology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome