title: Improved patient survival with simultaneous pancreas and kidney transplantation in recipients with diabetic end-stage renal disease.
abstract: OBJECTIVE
  We aimed to determine whether simultaneous pancreas and kidney (SPK) transplantation would improve patient and kidney graft survival in diabetic end-stage renal disease (ESRD) compared with kidney transplantation alone (KTA).
  
  
  METHODS
  Follow-up data were retrieved for all 630 patients with diabetic ESRD who had received SPK or KTA at our centre from 1983 to the end of 2010. Recipients younger than 55 years of age received either an SPK (n = 222) or, if available, a single live donor kidney (LDK; n = 171). Older recipients and recipients with greater comorbidity received a single deceased donor kidney (DDK; n = 237). Survival was analysed by the Kaplan-Meier method and in multivariate Cox regression analysis adjusting for recipient and donor characteristics.
  
  
  RESULTS
  Patient survival was superior in SPK compared with both LDK and DDK recipients in univariate analysis. Follow-up time (mean ± SD) after transplantation was 7.1 ± 5.7 years. Median actuarial patient survival was 14.0 years for SPK, 11.5 years for LDK and 6.7 years for DDK recipients. In multivariate analyses including recipient age, sex, treatment modality, time on dialysis and era, SPK transplantation was protective for all-cause mortality compared with both LDK (p = 0.02) and DDK (p = 0.029) transplantation. After the year 2000, overall patient survival improved compared with previous years (HR 0.40, 95% CI 0.30, 0.55; p < 0.001). Pancreas graft survival also improved after 2000, with a 5 year graft survival rate of 78% vs 61% in previous years (1988-1999).
  
  
  CONCLUSIONS
  Recipients of SPK transplants have superior patient survival compared with both LDK and DDK recipients, with improved results seen over the last decade.
authors.affiliation: Department of Transplant Medicine, Section of Nephrology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, 0372 Oslo, Norway. j.p.h.lindahl@medisin.uio.no
authors.forename: J P
authors.initials: JP
authors.lastname: Lindahl
authors.forename: A
authors.initials: A
authors.lastname: Hartmann
authors.forename: R
authors.initials: R
authors.lastname: Horneland
authors.forename: H
authors.initials: H
authors.lastname: Holdaas
authors.forename: A V
authors.initials: AV
authors.lastname: Reisæter
authors.forename: K
authors.initials: K
authors.lastname: Midtvedt
authors.forename: T
authors.initials: T
authors.lastname: Leivestad
authors.forename: O
authors.initials: O
authors.lastname: Oyen
authors.forename: T
authors.initials: T
authors.lastname: Jenssen
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000379:methods*; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
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