title: Excellent outcomes of simultaneous pancreas kidney transplantation in patients from rural and urban Australia: a national service experience.
abstract: BACKGROUND
  Simultaneous pancreas and kidney (SPK) transplantation is performed to restore normoglycemia and renal function in patients with type 1 diabetes mellitus and end-stage renal failure. The National Pancreas Transplant Unit (NPTU) in Sydney provides a service to a population spread across 7.4 million km. We aimed to see if SPK transplantation outcomes differed between recipients from metropolitan (M) centers and those from nonmetropolitan (NM) regions.
  
  
  METHODS
  Using a prospectively collected database, patient and graft survival were analyzed. Patients were categorized according to region of residence and by distance from the NPTU.
  
  
  RESULTS
  Between January 2001 and May 2010, 165 patients underwent first-time SPK transplantation at the NPTU. There were 126 M and 39 NM recipients. Median distance from the NPTU was 732 km for donors (range, 0-3930 km) and 887 km for recipients (range, 1-4114 km). Median follow-up was 5.2 years (range, 1.1-10.3 years). Actuarial 5-year patient survival was 94% in M and 95% in NM groups. At 5 years, non-death-censored pancreas graft survival was 75% and 82% among M and NM patients, respectively, while kidney allograft survival was 88% in M and 92% in NM groups. There was no significant difference in patient and graft survival between groups. Distance of donor and recipient from the NPTU did not influence graft or patient survival.
  
  
  CONCLUSIONS
  SPK transplantation can be performed with excellent outcomes at a national center with a vast catchment area, irrespective of donor or recipient location.
authors.affiliation: National Pancreas Transplant Unit, Westmead Hospital, Westmead, NSW 2145, Australia.
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Thwaites
authors.forename: Bina
authors.initials: B
authors.lastname: Gurung
authors.forename: Jinna
authors.initials: J
authors.lastname: Yao
authors.forename: Kathy
authors.initials: K
authors.lastname: Kable
authors.forename: Paul
authors.initials: P
authors.lastname: Robertson
authors.forename: Brendan J
authors.initials: BJ
authors.lastname: Ryan
authors.forename: Vincent W T
authors.initials: VW
authors.lastname: Lam
authors.forename: Henry C
authors.initials: HC
authors.lastname: Pleass
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Hawthorne
authors.forename: Richard D M
authors.initials: RD
authors.lastname: Allen
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D001315:Australia / Q000453:epidemiology; D016208:Databases, Factual / Q000706:statistics & numerical data; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality / Q000601:surgery; D003928:Diabetic Nephropathies / Q000401:mortality* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000401:mortality; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000401:mortality*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data*; D016035:Pancreas Transplantation / Q000401:mortality*; D012424:Rural Population / Q000706:statistics & numerical data*; D013222:State Medicine / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data*; D055815:Young Adult