title: Zero-mismatch deceased-donor kidney versus simultaneous pancreas-kidney transplantation.
abstract: BACKGROUND
  Patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease may receive a simultaneous pancreas-kidney (SPK), living-donor kidney (LDK), or deceased-donor kidney (DDK) with possible pancreas after kidney transplantation. SPK is associated with superior patient and kidney graft survival compared with DDK, whereas SPK and LDK have comparable outcomes. It is unclear whether SPK and LDK offer a survival benefit over zero-mismatch (0MM) DDK. In this study, we compared the outcomes of T1DM recipients using data from the Organ Procurement and Transplant Network/United Network for Organ Sharing.
  
  
  METHODS
  Adult (≥18 years) first-time transplant recipients with T1DM waitlisted for SPK and transplanted from 1995 to 2010 were included in this study. Patient and death-censored kidney graft survival were compared between 0MMDDK (n=228), mismatched (MM) DDK (n=964), 0MMSPK (n=215), MMSPK (n=11951), 2 haplotype identical (2hap) LDK (n=205), and non-2hapLDK (n=1719) recipients. Multivariate analysis was performed using stepwise Cox proportional hazards models.
  
  
  RESULTS
  At 7 years, patient and death-censored graft survival of 0MMDDK recipients (85% and 81%, respectively) were not statistically different from that of 0MMSPK (81% and 85%; log-rank P value vs. 0MMDDK, 0.17 and 0.48, respectively) and 2hapLDK recipients (89% and 86%; log-rank P value vs. 0MMDDK, 0.34 and 0.18, respectively). Among all groups, MMDDK showed the worst patient survival (71%; log-rank P value vs. 0MMDDK, 0.001)
  
  
  CONCLUSIONS
  Patient and kidney graft survival of 0MMDDK recipients were comparable to both SPK and LDK recipients. These findings suggest that T1DM patients awaiting SPK may consider accepting a 0MMDDK if an offer is available.
authors.affiliation: Division of Nephrology, Department of Medicine, David Geffen School of Medicine, University of California at Los Angeles, CA, USA.
authors.forename: Mandana
authors.initials: M
authors.lastname: Kamgar
authors.forename: Edmund
authors.initials: E
authors.lastname: Huang
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kamgar
authors.forename: Naowanit
authors.initials: N
authors.lastname: Nata
authors.forename: Napat
authors.initials: N
authors.lastname: Leeaphorn
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.forename: Suphamai
authors.initials: S
authors.lastname: Bunnapradist
mesh_terms: D000328:Adult; D005260:Female; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000401:mortality; D016016:Proportional Hazards Models; D014019:Tissue Donors; D014184:Transplantation, Homologous