title: Long-Term Outcomes of Kidney and Simultaneous Pancreas-Kidney Transplantation in Recipients With Type 1 Diabetes Mellitus: Silesian Experience.
abstract: BACKGROUND
  Kidney transplantation (KTx) markedly reduces mortality in patients with end-stage kidney disease (ESKD) caused by type 1 diabetes mellitus (T1DM). The outstanding issue is whether transplantation should be limited only to KTx, with further insulinotherapy, or combined with pancreas transplantation in patients with ESKD/T1DM. The goal of this study was to compare the results of simultaneous pancreas-kidney transplantation (SPKTx) and deceased donor KTx and to identify factors affecting patient and kidney graft survival in patients with ESKD/T1DM.
  
  
  METHODS
  Eighty-seven deceased donor KTx and 66 SPKTx operated on in the Silesia region of Poland between 1998 and 2013 were included in the retrospective analysis.
  
  
  RESULTS
  During the mean 6.7 ± 3.6 years of follow-up, fewer cardiovascular episodes were observed in SPKTx recipients than in KTx recipients (1.5% vs 12.6%; P < .05). Five-year patient survival (80.7% in SPKTx vs 77.5% in KTx) and kidney graft survival (66.1% in SPKTx vs 70.4% in KTx) did not differ between study groups. There were no differences in patient survival (log-rank test, P = .99) or kidney graft survival (P = .99) based on Kaplan-Meier curves. Multivariable Cox proportional hazard analysis failed to identify factors explaining patient and kidney graft survival. Five-year pancreas graft survival was 58.9%. SPKTx recipients had significantly higher estimated glomerular filtration rates during the 7-year posttransplant period and less frequently developed proteinuria (6.1% vs 23%; P < .01).
  
  
  CONCLUSIONS
  Pancreas transplantation reduced cardiovascular risk and prevented the development of proteinuria but did not improve patient and kidney graft survival in recipients with T1DM in the 7-year follow-up period.
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland. Electronic address: ziacek@mp.pl.
authors: J
authors: J
authors: Ziaja
authors: Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland.
authors: A
authors: A
authors: Kolonko
authors: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland.
authors: D
authors: D
authors: Kamińska
authors: Department of Pathophysiology, Medical University of Silesia, Katowice, Poland; Department of Internal Medicine and Oncological Chemotherapy, Medical University of Silesia, Katowice, Poland.
authors: J
authors: J
authors: Chudek
authors: Department of Statistics, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland.
authors: A J
authors: AJ
authors: Owczarek
authors: Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland.
authors: A
authors: A
authors: Kujawa-Szewieczek
authors: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland.
authors: M
authors: M
authors: Kuriata-Kordek
authors: Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland.
authors: K
authors: K
authors: Krzyżowska
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.
authors: J
authors: J
authors: Badura
authors: Department of Surgical and Transplant Nursing, Medical University of Warsaw, Warsaw, Poland; Polish Transplant Coordinating Center Poltransplant, Warsaw, Poland.
authors: J
authors: J
authors: Czerwiński
authors: Department of Statistics, School of Pharmacy with the Division of Laboratory Medicine in Sosnowiec, Medical University of Silesia, Katowice, Poland.
authors: E
authors: E
authors: Jęrdusik
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.
authors: R
authors: R
authors: Król
authors: Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland.
authors: M
authors: M
authors: Klinger
authors: Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland.
authors: A
authors: A
authors: Więcek
authors: Department of General, Vascular and Transplant Surgery, Medical University of Silesia, Katowice, Poland.
authors: L
authors: L
authors: Cierpka
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000009:adverse effects / Q000401:mortality; D011044:Poland; D011507:Proteinuria / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome