title: Pancreas graft survival in simultaneous pancreas-kidney versus pancreas-after-kidney and pancreas alone transplantations: a single institution experience.
abstract: BACKGROUND
  Pancreas transplantation offers excellent outcomes today in patients who have type-1 diabetes mellitus (DM) with difficult control in terms of increasing patient and pancreatic graft survival. Different factors in donors, recipients, and the perioperative period have been associated with long-term graft survival. The aim of this study was to compare pancreatic graft survival in simultaneous pancreas-kidney transplantation (SPK) and the other two modalities, pancreas-alone and pancreas-after-kidney transplantation (non-SPK), at our institution.
  
  
  METHODS
  This retrospective cohort study included 63 pancreas transplantation patients from January 2007 to May 2012 at our institution. The patients were divided into two groups: SPK and non-SPK transplantations. We excluded those patients who had transplants with vascular graft loss. The primary endpoint was 1-year and overall graft survival with consideration of multiple relevant variables. Non-parametric tests were calculated with the statistical package SPSS 20 (SPSS INC, Chicago, IL).
  
  
  RESULTS
  The 1-year and overall graft survival in this period was 87.3% and 82.5%, respectively. The median follow-up was 963 days. The causes of graft loss were vascular (64%) and immunologic (34%). Finally, we included 56 pancreas transplantations, 46 (82%) were SPK and 10 (18%) non-SPK. The donor and recipient characteristics were similar in both groups, except for the duration of DM (SPK 22 years vs. non-SPK 29 years) and recipient body mass index (SPK 23 vs. non-SPK 28); P = .042 and P = .003, respectively. The cold ischemia time was 563 minutes (standard deviation, 145). Bivariate analysis showed that long-term graft loss was only influenced by matching for gender (P = .023). Using the Kaplan-Meier method, the pancreas graft survival was better in SPK than in non-SPK transplants (log rank .038).
  
  
  CONCLUSIONS
  Patients who receive pancreas-alone or pancreas-after-kidney grafts have shorter long-term graft survival. Multiple strategies should be applied to improve immunologic surveillance and obtain an early diagnosis of graft rejection.
authors: Department of Digestive Surgery and Transplantation, Hospital Regional Universitario Carlos Haya, Málaga, Spain. Electronic address: custodiamc1904@gmail.com.
authors: M C
authors: MC
authors: Montiel-Casado
authors: J A
authors: JA
authors: Pérez-Daga
authors: J M
authors: JM
authors: Aranda-Narváez
authors: I
authors: I
authors: Fernández-Burgos
authors: B
authors: B
authors: Sánchez-Pérez
authors: F J
authors: FJ
authors: León-Díaz
authors: M
authors: M
authors: Cabello-Díaz
authors: D
authors: D
authors: Rodríguez-Burgos
authors: D
authors: D
authors: Hernández-Marrero
authors: J
authors: J
authors: Santoyo-Santoyo
mesh_terms: D000328:Adult; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D042241:Early Diagnosis; D005260:Female; D006084:Graft Rejection / Q000175:diagnosis / Q000276:immunology; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013030:Spain; D018709:Statistics, Nonparametric; D013997:Time Factors; D016896:Treatment Outcome