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Pancreas-kidney transplant may be best for type 1 diabetics with kidney disease

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – As a treatment for type 1 diabetes with kidney dysfunction, simultaneous pancreas-kidney transplantation (SPK) provides better survival than kidney transplantation alone, even if pancreas transplantation is performed later, new research shows.

However, the pancreas graft must be functional 12-months post-transplantation for the survival benefit of SPK transplantation to be realized, the researchers report. Without a functioning pancreas graft, the survival rates with SPK are similar to those seen with kidney transplantation alone.

Furthermore, survival rates in the first year are slightly lower with SPK transplantation than with living donor kidney-only transplantation, 95.9% vs 97.2% (p =0.04).

Patients with type 1 diabetes and kidney dysfunction have a difficult decision to make, senior author Dr. Alexander C. Wiseman, from the University of Colorado Denver Health Sciences Center in Aurora, comments in a press release. “Should they try to get on the waiting list for SPK and assume the greater surgical risk, or should they accept a kidney from a living donor and live with continued diabetes.”

The current findings, Dr. Wiseman notes, suggest that “the chances for better long-term success favor the SPK option, particularly if the waiting time for an SPK is not long — this varies with regions of the US.”

The study, reported in the Clinical Journal of the American Society of Nephrology for May, included 7952 patients who underwent SPK, 1062 who underwent living donor kidney transplantation, and 616 who underwent deceased donor kidney transplantation from 1997 to 2005.

At 84 months post-transplantation, survival in SPK-treated patients with functional pancreas grafts at 12 months was 88.6%, significantly higher than the 80.0%, 73.9%, and 64.8% rates seen in the living donor kidney transplant, SPK/non-functioning pancreatic graft, and deceased donor kidney transplant groups, respectively. Graft survival was also highest in the SPK, functional pancreas group.

These findings were largely unchanged after considering kidney graft patients who later underwent pancreas transplantation, the authors note.

“These data help further clarify the decision-making of SPK versus kidney-alone transplant options of patients and providers,” Dr. Wiseman and colleagues conclude.

Clin J Am Soc Nephrol 2009;4:988-995.