title: Pancreas-after-kidney versus synchronous pancreas-kidney transplantation:  comparison of intermediate-term results.
abstract: BACKGROUND
  Controversy persists over the safety and efficacy of pancreas transplantation in patients with insulin-dependent diabetes mellitus who have received a prior kidney transplant.
  
  
  METHODS
  We compared the outcomes of recipients who received either Synchronous-Pancreas Kidney-Transplantation (SPK, n=123) or Pancreas-After-Kidney-Transplants(n=49)at our institution between August 2002 to January 2010.
  
  
  RESULTS
  Donor and recipient demographics were similar. Time interval between kidney and pancreas transplantation was 5.9 ± 3.8 (4.8 [1.6-12.2]) years. The majority of kidney-recipients in PAK group were transplanted at outside institutions and referred to us for PAK. Most patients received thymoglobulin induction and were maintained on tacrolimus, MMF, and prednisone. For SPK versus PAK recipients, there was no difference in median of length of hospital stay or incidence of overall complications. All PAK recipients are alive with functioning kidney grafts, whereas the 1-, 3-, and 5-year SPK patient survival rates were 98%,96%,and 94%, P=0.09. The 1-,3-, and 5-yr uncensored pancreas survival rates for SPK versus PAK were 93% vs. 90%, 90% vs. 90%, and 82% versus 85%, respectively (P=0.4).
  
  
  CONCLUSIONS
  Glycemic control and intermediate survival outcomes were similar in both groups. Pancreas-graft outcomes in SPK and PAK were equivalent in our study, but our specific population entailed among other factors a long K to PAK time interval; PAK could be a comparable option to SPK for patients with access to kidney grafts.
authors.affiliation: Department of Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Fateh
authors.initials: F
authors.lastname: Bazerbachi
authors.forename: Markus
authors.initials: M
authors.lastname: Selzner
authors.forename: Max A
authors.initials: MA
authors.lastname: Marquez
authors.forename: Andrea
authors.initials: A
authors.lastname: Norgate
authors.forename: Ian D
authors.initials: ID
authors.lastname: McGilvray
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Schiff
authors.forename: Mark S
authors.initials: MS
authors.lastname: Cattral
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D016035:Pancreas Transplantation / Q000276:immunology / Q000401:mortality; D012189:Retrospective Studies; D015996:Survival Rate; D016559:Tacrolimus / Q000627:therapeutic use; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D009173:Mycophenolic Acid; D016559:Tacrolimus