title: Pancreas-kidney transplantation is associated with reduced fracture risk compared with kidney-alone transplantation in men with type 1 diabetes.
abstract: Both type 1 diabetes mellitus and end-stage renal disease are associated with increased fracture risk, likely because of metabolic abnormalities that reduce bone strength. Simultaneous pancreas-kidney transplantation is a treatment of choice for patients with both disorders, yet the effects of simultaneous pancreas-kidney and kidney transplantation alone on post-transplantation fracture risk are unknown. From the United States Renal Data System, we identified 11,145 adults with type 1 diabetes undergoing transplantation, of whom 4933 had a simultaneous pancreas-kidney transplant and 6212 had a kidney-alone transplant between 2000 and 2006. Post-transplantation fractures resulting in hospitalization were identified from discharge codes. Time to first fracture was modeled and propensity score adjustment was used to balance covariates between groups. Fractures occurred in significantly fewer (4.7%) of pancreas-kidney compared with kidney-alone transplant (5.9%) cohorts. After gender stratification and adjustment for fracture covariates, pancreas-kidney transplantation was associated with a significant 31% reduction in fracture risk in men (hazard risk 0.69). Older age, white race, prior dialysis, and pre-transplantation fracture were also associated with increased fracture risk. Prospective studies are needed to determine the gender-specific mechanisms by which pancreas-kidney transplantation reduces fracture risk in men.
authors.affiliation: Penn State Hershey College of Medicine, Hershey, Pennsylvania, USA.
authors.forename: Lucas E
authors.initials: LE
authors.lastname: Nikkel
authors.forename: Sapna P
authors.initials: SP
authors.lastname: Iyer
authors.forename: Sumit
authors.initials: S
authors.lastname: Mohan
authors.forename: Amy
authors.initials: A
authors.lastname: Zhang
authors.forename: Donald J
authors.initials: DJ
authors.lastname: McMahon
authors.forename: Bekir
authors.initials: B
authors.lastname: Tanriover
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.forename: Lloyd
authors.initials: L
authors.lastname: Ratner
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Hollenbeak
authors.forename: Mishaela R
authors.initials: MR
authors.lastname: Rubin
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Shane
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Nickolas
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology*; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000401:mortality; D051436:Renal Insufficiency, Chronic / Q000150:complications; D012306:Risk; D012727:Sex Characteristics