Single Center Results of Simultaneous Pancreas-kidney Transplantation in Patients with Type 2 Diabetes

Overview

Journal Am J Transplant

Publisher Elsevier

Specialty General Surgery

Date 2020 Dec 22

PMID 33350048

Citations 8

Authors

Phuoc H Pham

Lily N Stalter

Eric J Martinez

Jesse F Wang

Bridget M Welch

Glen Leverson

Nicholas Marka

Talal Al-Qaoud

Didier Mandelbrot

Sandesh Parajuli

Hans W Sollinger

Dixon Kaufman

Robert R Redfield

Jon S Odorico

Affiliations

Soon will be listed here.

Abstract

Studies have found similar outcomes of Simultaneous Pancreas-Kidney transplantation (SPKT) in patients with Type 2 (T2D) and Type 1 diabetes (T1D). However, there are scarce data evaluating the association of recipient factors such as age, BMI, or pretransplant insulin requirements with outcomes, thus the criteria for the optimal recipient selection remains unclear. In this study, 284 T1D and 39 T2D patients, who underwent SPKT between 2006 and 2017 with 1 year of follow-up at minimum, were assessed for potential relationship of pretransplant BMI and insulin requirements with posttransplant diabetes and pancreatic graft failure. Kaplan-Meier analysis showed similar rates of freedom from posttransplant diabetes (94.7% T2D vs. 92.3% T1D at 1 yr, and 88.1% T2D vs. 81.1% T1D at 5 yrs) and graft survival (89.7% T2D vs. 90.4% T1D at 1 yr, and 89.7% T2D vs. 81.2% T1D at 5 yrs). There was no significant association between BMI or pretransplant insulin requirements with posttransplant diabetes occurrence in either T1D (p = .10, .43, respectively) or T2D (p = .12, .63) patients in the cohort; or with graft failure (T1D: p = .40, .09; T2D: p = .71, .28). These observations suggest a less restricted approach to selective use of SPKT in patients with T2D.

Citing Articles

Risk Factors for Early Post-transplant Weight Changes Among Simultaneous Pancreas-kidney Recipients and Impact on Outcomes.

Parajuli S, Tamburrini R, Aziz F, Dodin B, Astor B, Mandelbrot D Transplant Direct. 2024; 10(11):e1720.

PMID: 39440200 PMC: 11495727. DOI: 10.1097/TXD.0000000000001720.

Simultaneous Pancreas-Kidney Transplant Outcomes Stratified by Autoantibodies Status and Pretransplant Fasting C-peptide.

Parajuli S, Tamburrini R, Aziz F, Dodin B, Astor B, Mandelbrot D Transplant Direct. 2024; 10(11):e1721.

PMID: 39399059 PMC: 11469883. DOI: 10.1097/TXD.0000000000001721.

Analysis of Rejection, Infection and Surgical Outcomes in Type I Versus Type II Diabetic Recipients After Simultaneous Pancreas-Kidney Transplantation.

Martinez E, Pham P, Wang J, Stalter L, Welch B, Leverson G Transpl Int. 2024; 37:13087.

PMID: 39364120 PMC: 11446817. DOI: 10.3389/ti.2024.13087.

Multi-Centre UK Analysis of Simultaneous Pancreas and Kidney (SPK) Transplant in Recipients With Type 2 Diabetes Mellitus.

Owen R, Carr H, Counter C, Tingle S, Thompson E, Manas D Transpl Int. 2024; 36:11792.

PMID: 38370534 PMC: 10869449. DOI: 10.3389/ti.2023.11792.

Broccoli Improves Lipid Metabolism and Intestinal Flora in Mice with Type 2 Diabetes Induced by HFD and STZ Diet.

Li X, Cai Z, Yang F, Wang Y, Pang X, Sun J Foods. 2024; 13(2).

PMID: 38254574 PMC: 10814524. DOI: 10.3390/foods13020273.

References

Redfield R, Scalea J, Odorico J . Simultaneous pancreas and kidney transplantation: current trends and future directions. Curr Opin Organ Transplant. 2015; 20(1):94-102. PMC: 4286161. DOI: 10.1097/MOT.0000000000000146. View

Neidlinger N, Singh N, Klein C, Odorico J, Munoz del Rio A, Becker Y . Incidence of and risk factors for posttransplant diabetes mellitus after pancreas transplantation. Am J Transplant. 2010; 10(2):398-406. DOI: 10.1111/j.1600-6143.2009.02935.x. View

Gruessner A, Sutherland D . Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004. Clin Transplant. 2005; 19(4):433-55. DOI: 10.1111/j.1399-0012.2005.00378.x. View

Al-Qaoud T, Odorico J, Redfield 3rd R . Pancreas transplantation in type 2 diabetes: expanding the criteria. Curr Opin Organ Transplant. 2018; 23(4):454-460. DOI: 10.1097/MOT.0000000000000553. View

Dean P, Kudva Y, Larson T, Kremers W, Stegall M . Posttransplant diabetes mellitus after pancreas transplantation. Am J Transplant. 2007; 8(1):175-82. DOI: 10.1111/j.1600-6143.2007.02018.x. View

Gruessner A, Laftavi M, Pankewycz O, Gruessner R . Simultaneous Pancreas and Kidney Transplantation-Is It a Treatment Option for Patients With Type 2 Diabetes Mellitus? An Analysis of the International Pancreas Transplant Registry. Curr Diab Rep. 2017; 17(6):44. DOI: 10.1007/s11892-017-0864-5. View

. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012; 36 Suppl 1:S67-74. PMC: 3537273. DOI: 10.2337/dc13-S067. View

Gondolesi G, Aguirre N, Ramisch D, Mos F, Pedraza N, Fortunato M . Pancreas Transplantation at a Single Latin-American Center; Overall Results with Type 1 and Type 2 Diabetes Mellitus. Transplant Proc. 2018; 50(5):1475-1481. DOI: 10.1016/j.transproceed.2018.03.022. View

Sollinger H, Odorico J, Becker Y, DAlessandro A, Pirsch J . One thousand simultaneous pancreas-kidney transplants at a single center with 22-year follow-up. Ann Surg. 2009; 250(4):618-30. DOI: 10.1097/SLA.0b013e3181b76d2b. View

10.

Sampaio M, Kuo H, Bunnapradist S . Outcomes of simultaneous pancreas-kidney transplantation in type 2 diabetic recipients. Clin J Am Soc Nephrol. 2011; 6(5):1198-206. PMC: 3087789. DOI: 10.2215/CJN.06860810. View

11.

Axelrod D, Sung R, Meyer K, Wolfe R, Kaufman D . Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization. Am J Transplant. 2010; 10(4):837-845. DOI: 10.1111/j.1600-6143.2009.02996.x. View

12.

Singh R, Stratta R . Advances in immunosuppression for pancreas transplantation. Curr Opin Organ Transplant. 2008; 13(1):79-84. DOI: 10.1097/MOT.0b013e3282f2fd91. View

13.

Lindahl J, Reinholt F, Eide I, Hartmann A, Midtvedt K, Holdaas H . In patients with type 1 diabetes simultaneous pancreas and kidney transplantation preserves long-term kidney graft ultrastructure and function better than transplantation of kidney alone. Diabetologia. 2014; 57(11):2357-65. DOI: 10.1007/s00125-014-3353-2. View

14.

Butler A, Janson J, Bonner-Weir S, Ritzel R, Rizza R, Butler P . Beta-cell deficit and increased beta-cell apoptosis in humans with type 2 diabetes. Diabetes. 2002; 52(1):102-10. DOI: 10.2337/diabetes.52.1.102. View

15.

Concepcion B, Feurer I, Rega S, Niederhaus S, Odorico J, Forbes R . Geographic Disparities in Access to Simultaneous Pancreas and Kidney Transplant in the Pre- and Post-Pancreas Allocation System Eras. Transplantation. 2019; 104(3):623-631. DOI: 10.1097/TP.0000000000002850. View

16.

Hau H, Jahn N, Brunotte M, Lederer A, Sucher E, Rasche F . Short and long-term metabolic outcomes in patients with type 1 and type 2 diabetes receiving a simultaneous pancreas kidney allograft. BMC Endocr Disord. 2020; 20(1):30. PMC: 7045477. DOI: 10.1186/s12902-020-0506-9. View

17.

Chan C, Chim T, Leung K, Tong C, Wong T, Leung G . Simultaneous pancreas and kidney transplantation as the standard surgical treatment for diabetes mellitus patients with end-stage renal disease. Hong Kong Med J. 2016; 22(1):62-9. DOI: 10.12809/hkmj154613. View

18.

Lo D, Sayed B, Turgeon N . Pancreas transplantation in unconventional recipients. Curr Opin Organ Transplant. 2016; 21(4):393-8. DOI: 10.1097/MOT.0000000000000334. View

19.

Afaneh C, Rich B, Aull M, Hartono C, Leeser D, Kapur S . Pancreas transplantation: does age increase morbidity?. J Transplant. 2011; 2011:596801. PMC: 3134200. DOI: 10.1155/2011/596801. View

20.

Fridell J, Niederhaus S, Curry M, Urban R, Fox A, Odorico J . The survival advantage of pancreas after kidney transplant. Am J Transplant. 2018; 19(3):823-830. DOI: 10.1111/ajt.15106. View