title: Combined pancreas-kidney transplantation for patients with end-stage nephropathy caused by type-2 diabetes mellitus.
abstract: BACKGROUND
  Simultaneous pancreas-kidney (SPK) transplantation is widely accepted as an optimal therapeutic option for patients with type 1 diabetes mellitus (T1DM) and end-stage renal disease, but the indication for patients with type 2 diabetes mellitus (T2DM) is still controversially discussed.
  
  
  METHODS
  Twenty-one T2DM recipients of a first combined pancreas-kidney graft performed at our center during a 9-year period were retrospectively analyzed with regard to demographic characteristics; cardiovascular risk factors; surgical, immunological, and infectious complications; and patient and graft survivals and compared with T1DM recipients (n=195) and 32 T2DM patients who received a kidney transplant alone (KTA) during the same period.
  
  
  RESULTS
  Patient survival at 1 and 5 years was 96.9% and 91.6% for the T1DM group, 90.5% and 80.1% for the T2DM group, and 87.1% and 54.2% for the T2DM KTA group, respectively (P<0.001). Actuarial pancreas graft survival for SPK recipients at 1 and 5 years was calculated to be 92.6% and 80.7% for the T1DM group and 81.0% and 75.9% for the T2DM group, respectively (P=0.19). Kidney allograft survival at 5 years was 83.6% for T1DM, 80.4% for T2DM, and 52.7% for T2DM KTA (P<0.0001). Multivariate analysis adjusting for donor and recipient age, secondary complications of diabetes, body mass index, waiting time, cold ischemic time, delayed graft function, and coronary risk factors showed that differences did not remain statistically significant.
  
  
  CONCLUSIONS
  Favorable results can be achieved with SPK transplantation in type 2 diabetics with a low coronary risk profile. A high cardiac death rate impacts results of KTA and calls for stringent selection.
authors: Department of Visceral, Transplant, and Thoracic Surgery, Innsbruck Medical University, Austria. christian.margreiter@uki.at
authors: Christian
authors: C
authors: Margreiter
authors: Thomas
authors: T
authors: Resch
authors: Rupert
authors: R
authors: Oberhuber
authors: Felix
authors: F
authors: Aigner
authors: Herbert
authors: H
authors: Maier
authors: Robert
authors: R
authors: Sucher
authors: Stefan
authors: S
authors: Schneeberger
authors: Hanno
authors: H
authors: Ulmer
authors: Claudia
authors: C
authors: Bösmüller
authors: Raimund
authors: R
authors: Margreiter
authors: Johann
authors: J
authors: Pratschke
authors: Robert
authors: R
authors: Öllinger
mesh_terms: D000328:Adult; D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000401:mortality / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult