title: Long-term pancreatic allograft survival after renal retransplantation in prior simultaneous pancreas-kidney recipients.
abstract: Over a 23-year period, our center performed 82 renal retransplants in prior simultaneous pancreas-kidney recipients with functioning pancreatic allografts. All patients were insulin-independent at retransplantation. We aimed to quantify the risk of returning to insulin therapy and to identify factors that predispose patients to pancreatic allograft failure after renal retransplantation. Among these 82 patients, pancreatic allograft survival after renal retransplantation was 78%, 49% and 40% at 1, 5 and 10 years. When analyzing risk factors, we unexpectedly found no clear relationship between the cause of primary renal allograft failure, hemoglobin A1c (HbA1c) or fasting C-peptide level at retransplant and subsequent pancreatic allograft failure. An elevated HbA1c in the month after renal retransplant correlated with subsequent pancreatic graft loss and patients experiencing pancreatic graft loss were more likely to subsequently lose their renal retransplant. Although it is difficult to prospectively identify those patients who will return to insulin therapy after repeat renal transplantation, the relatively high frequency of this event mandates that this risk be conveyed to patients. Nonetheless, the survival benefit associated with renal retransplantation justifies pursuing retransplantation in this population.
authors.affiliation: Division of Transplantation, University of Maryland School of Medicine, University of Maryland, Baltimore, MD, USA.
authors.forename: J
authors.initials: J
authors.lastname: Lamattina
authors.forename: H
authors.initials: H
authors.lastname: Sollinger
authors.forename: Y
authors.initials: Y
authors.lastname: Becker
authors.forename: J
authors.initials: J
authors.lastname: Mezrich
authors.forename: J
authors.initials: J
authors.lastname: Pirsch
authors.forename: J
authors.initials: J
authors.lastname: Odorico
mesh_terms: D000328:Adult; D002096:C-Peptide / Q000378:metabolism; D003928:Diabetic Nephropathies / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D006084:Graft Rejection / Q000209:etiology* / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D008297:Male; D016035:Pancreas Transplantation / Q000276:immunology / Q000401:mortality / Q000473:pathology*; D011183:Postoperative Complications; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous
chemical_list: D002096:C-Peptide; D006442:Glycated Hemoglobin