Outcomes Associated with Pancreas Transplant in Patients with CKD and Type 1 Diabetes

Both pancreas transplantation alone (PTA) and islet cell transplantation (ICT) have been associated with peri-operative declines in estimated glomerular filtration rate (eGFR), a decline that is less than that associated with medically managed diabetes. According to Rashikh Choudhury, MD, and colleagues in the department of surgery-division of transplantation surgery at the University of Colorado Hospital, Aurora, PTA and ICT have demonstrated long-term stabilization of chronic kidney disease (CKD) in patients with type 2 diabetes. However, there are few data available on whether transplantation reduces future need for kidney transplantation and on mortality rates in that patient population.

In a virtual poster presented at the 28th International Congress of the Transplantation Society, the researchers reported results of an analysis of patients with type 1 diabetes and CKD. The poster was titled Pancreas Transplant in Chronic Kidney Disease for Type 1 Diabetic Patients.

The researchers created a decision analytic Markov state transition model to simulate the life of patients with type 1 diabetes and CKD who underwent one of three interventions: (1) PTA alone; (2) ICT; or (3) medical management. For each intervention, in simulated cohorts of 3000 patients, estimated declines in eGFR, the chance of requiring a kidney transplant, and mortality were estimated. Base case patients were defined as type 1 diabetic patients 30 years of age with an initial eGFR of 30 mL/min/1.73 m2. Sensitivity analysis of initial eGFR was performed, and Markov model parameters were extracted from literature review.

Across a spectrum of initial eGFR from 15 mL/min/1.73 m2 to 60 mL/min/1.73 m2, PTA and ICT were associated with improved long-term survival. For base case patients, patients in the ICT intervention group required few transplants and gained 17.8 years of life compared with medically managed patients, and 3.8 years of life compared with patients in the PTA intervention group.

“ICT is associated with stabilization of eGFR, thereby reducing the need for future kidney transplantation and improving long-term survival,” the researchers said.

Source: Choudhury R, Yoeli D, Moore HB, Yaffe H, Nydam TL, Kennealey P. Pancreas transplant in chronic kidney disease for type 1 diabetic patients. Abstract of a poster presented at the virtual 28th International Congress of the Transplantation Society (Abstract P-4.109), September 13-16, 2020.