Patient and Graft Survival in SPK Transplant Among Patients with Diabetes

Luz E. Liriano-Ward, MD, and colleagues at Montefiore Medical Center, Bronx, New York, conducted a retrospective review to examine and compare short-term and long-term outcomes in simultaneous kidney and pancreas transplant (SPK) recipients with a history of type 2 diabetes compared with recipients with type 1 diabetes. The review included all SPK transplant recipients >18 years of age at the center from June 2014 to December 2021.

The researchers reported results of the review during a poster session at the American Society of Nephrology Kidney Week 2022. The poster was titled Post-Simultaneous Kidney and Pancreas Transplant Outcomes in Type 2 Diabetics Compared to Type 1 Diabetics.

During the study period, a total of 107 SPK transplants were performed at the center. Of those, 46.7% had type 2 diabetes and 53.3% had type 1. Of the total cohort, 80% were Black or Hispanic; there were no racial differences between the two study groups.

Those with type 2 diabetes were older (median age 49.5 vs 35 years; P<.001), had lower pretransplant hemoglobin A1c (HbA1c) (7.6 vs 8.4; P=.04),and had higher c-peptide (5.1 vs 1.1; P<.001) compared with those with type 1 diabetes. The two groups were similar in body mass index (25.6 in type 1 vs 27 in type 2; P=.096), pretransplant insulin requirements, history of hypertension, hyperlipidemia, end-stage renal disease, and dialysis vintage.

Patients in the type 1 diabetes group developed more rejection (22.8% vs 2%; P=.002) and cytomegalovirus viremia (31.4% vs 10%; P=.01) compared with recipients with type 2 diabetes. The groups were similar in length of hospital stay, 30-day readmissions, the incidence of delayed graft function in both kidney and pancreas allografts, hypoglycemia, and the need for oral antiglycemic drugs posttransplant.

At 3 months and 6 months posttransplant, mean serum creatinine levels were similar in the two groups. At 1 year posttransplant, patients with type 2 diabetes had better kidney function, with mean estimated glomerular filtration rate of 71 mL/min/1.73 m2 versus 61 mL/min/1.73 m2 among patients with type 1 diabetes. There was no difference in renal function at last follow-up.

At 6 months posttransplant, the two groups were similar in HbA1c levels; levels were also similar at 1 year posttransplant.

Median follow-up was 22 months. During the follow-up period, in the group with type 2 diabetes, patient survival was 98%, kidney graft survival was 100% and pancreas graft survival was 92%.

“Type 1 diabetics were more likely to develop acute rejection and CMV viremia as compared to type 2 diabetics. Both patient and graft survival are comparable between the two groups,” the researchers said.

Source: Liriano-Ward LE, Al Azzi Y, Kapoor S, Ajaimy M, Pynadath CT, Akalin E. Post-simultaneous kidney and pancreas transplant outcomes in type 2 diabetics compared to type 1 diabetics. FR-PO827. Abstract of a poster presented at the American Society of Nephrology Kidney Week 2022; November 4, 2022; Orlando, Florida.