Favorable Outcomes in Older Recipients Receiving Simultaneous Pancreas Kidney Transplantation

Overview

Journal Transplant Direct

Publisher Wolters Kluwer

Specialty General Surgery

Date 2022 Nov 21

PMID 36406897

Authors

Pooja Budhiraja

Raymond L Heilman

Kunam S Reddy

Caroline C Jadlowiec

Hassan A Khamash

Jacob Ninan

Swetha Reddy

Hay Me Me

Suman Misra

Nitin Katariya

Harini A Chakkera

Affiliations

Soon will be listed here.

Abstract

Methods: This is a retrospective single-center study from July 2003 to March 2021 with a median follow-up of 7.5 y.

Results: There were 104 recipients in the SPKT and 80 in the LDKT group. The mean age was 56 y in SPKT and 58 y in LDKT. There were 55% male recipients in the SPKT group versus 75% in LDKT. The duration of diabetes was 32 y in SPKT versus 25 y in LDKT. The number of preemptive transplants and length of dialysis were similar. However, the wait time was shorter for LDKT (269 versus 460 d). Forty-nine percent of the LDKT recipients received the organ within 6 mo of being waitlisted compared with 28% of SPKT recipients ( = 0.001). Donor age was lower in the SPKT group (27 versus 41 y). The estimated 5-y death censored kidney survival was 92% versus 98%, and 5-y patient survival was 86% versus 89% for SPKT versus LDKT. Death censored kidney and patient survival, acute kidney rejection by 1 y, and BK viremia were similar between the 2 groups. There were 17 pancreas graft losses within 1 y of transplant, the majority related to surgical complications, and it was not associated with increased mortality.

Conclusions: SPKT in selected recipients aged 50 and above can have excellent outcomes similar to LDKT recipients.

References

Shah A, Mangus R, Powelson J, Samy K, Taber T, Goble M . Impact of recipient age on whole organ pancreas transplantation. Clin Transplant. 2012; 27(1):E49-55. DOI: 10.1111/ctr.12047. View

Ablorsu E, Ghazanfar A, Mehra S, Campbell B, Riad H, Pararajasingam R . Outcome of pancreas transplantation in recipients older than 50 years: a single-centre experience. Transplantation. 2008; 86(11):1511-4. DOI: 10.1097/TP.0b013e3181891cd6. View

Lehner L, Ollinger R, Globke B, Naik M, Budde K, Pratschke J . Impact of Early Pancreatic Graft Loss on Outcome after Simultaneous Pancreas-Kidney Transplantation (SPKT)-A Landmark Analysis. J Clin Med. 2021; 10(15). PMC: 8347953. DOI: 10.3390/jcm10153237. View

Wiseman A, Gralla J . Simultaneous pancreas kidney transplant versus other kidney transplant options in patients with type 2 diabetes. Clin J Am Soc Nephrol. 2012; 7(4):656-64. DOI: 10.2215/CJN.08310811. View

Dean P, Kukla A, Stegall M, Kudva Y . Pancreas transplantation. BMJ. 2017; 357:j1321. DOI: 10.1136/bmj.j1321. View

Montagud-Marrahi E, Molina-Andujar A, Pane A, Ramirez-Bajo M, Amor A, Esmatjes E . Outcomes of pancreas transplantation in older diabetic patients. BMJ Open Diabetes Res Care. 2020; 8(1). PMC: 7059452. DOI: 10.1136/bmjdrc-2019-000916. View

Siskind E, Maloney C, Akerman M, Alex A, Ashburn S, Barlow M . An analysis of pancreas transplantation outcomes based on age groupings--an update of the UNOS database. Clin Transplant. 2014; 28(9):990-4. DOI: 10.1111/ctr.12407. View

Johansen K, Chertow G, Foley R, Gilbertson D, Herzog C, Ishani A . US Renal Data System 2020 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2021; 77(4 Suppl 1):A7-A8. PMC: 8148988. DOI: 10.1053/j.ajkd.2021.01.002. View

Bijkerk R, Duijs J, Khairoun M, Ter Horst C, van der Pol P, Mallat M . Circulating microRNAs associate with diabetic nephropathy and systemic microvascular damage and normalize after simultaneous pancreas-kidney transplantation. Am J Transplant. 2015; 15(4):1081-90. DOI: 10.1111/ajt.13072. View

10.

Boggi U, Rosati C, Marchetti P . Follow-up of secondary diabetic complications after pancreas transplantation. Curr Opin Organ Transplant. 2013; 18(1):102-10. DOI: 10.1097/MOT.0b013e32835c28c5. View

11.

Young B, Gill J, Huang E, Takemoto S, Anastasi B, Shah T . Living donor kidney versus simultaneous pancreas-kidney transplant in type I diabetics: an analysis of the OPTN/UNOS database. Clin J Am Soc Nephrol. 2009; 4(4):845-52. PMC: 2666422. DOI: 10.2215/CJN.02250508. View

12.

Reddy K, Stablein D, Taranto S, Stratta R, Johnston T, Waid T . Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis. 2003; 41(2):464-70. DOI: 10.1053/ajkd.2003.50057. View

13.

Morath C, Zeier M, Dohler B, Schmidt J, Nawroth P, Opelz G . Metabolic control improves long-term renal allograft and patient survival in type 1 diabetes. J Am Soc Nephrol. 2008; 19(8):1557-63. PMC: 2488262. DOI: 10.1681/ASN.2007070804. View

14.

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

15.

Reddy K, Devarapalli Y, Mazur M, Hamawi K, Chakkera H, Moss A . Alemtuzumab with rapid steroid taper in simultaneous kidney and pancreas transplantation: comparison to induction with antithymocyte globulin. Transplant Proc. 2010; 42(6):2006-8. DOI: 10.1016/j.transproceed.2010.05.090. View

16.

Gurung K, Alejo J, Rogers J, Farney A, Orlando G, Jay C . Recipient age and outcomes following simultaneous pancreas-kidney transplantation in the new millennium: Single-center experience and review of the literature. Clin Transplant. 2021; 35(8):e14302. DOI: 10.1111/ctr.14302. View

17.

Pham P, Stalter L, Martinez E, Wang J, Welch B, Leverson G . Single center results of simultaneous pancreas-kidney transplantation in patients with type 2 diabetes. Am J Transplant. 2020; 21(8):2810-2823. PMC: 8217396. DOI: 10.1111/ajt.16462. View

18.

Heilman R, Khamash H, Huskey J, Chakkera H, Batra R, Katariya N . Kidney Transplant Program at the Mayo Clinic in Arizona. Clin Transpl. 2015; :61-8. View

19.

Messner F, Leemkuil M, Yu Y, Massie A, Krendl F, Benjamens S . Recipient age and outcome after pancreas transplantation: a retrospective dual-center analysis. Transpl Int. 2021; 34(4):657-668. PMC: 8049064. DOI: 10.1111/tri.13845. View

20.

Norman S, Kommareddi M, Ojo A, Luan F . Early pancreas graft failure is associated with inferior late clinical outcomes after simultaneous kidney-pancreas transplantation. Transplantation. 2011; 92(7):796-801. PMC: 3831506. DOI: 10.1097/TP.0b013e31822dc36b. View