Graft and Patient Survival Following Simultaneous Pancreas-Kidney Transplant

For patients with diabetes and end-stage kidney disease, the only persistently successful treatment is simultaneous pancreas-kidney transplant (SPK). However, according to M. Ji and colleagues, SPK has a technical failure rate of 7% to 22%. Technical failure is defined as a graft loss within 3 months of transplantation.

The researchers conducted a study designed to quantify the impact of 3-month pancreas function on kidney graft failure and patient survival following SPK in patients with type 1 diabetes. Results of the study were reported during a poster session at the 2022 American Transplant Congress in a poster titled Three-Month Pancreas Graft Function Significantly Influences Survival Following Simultaneous Pancreas-Kidney Transplantation in Type 1 Diabetes Patients.

The researchers utilized data from a national transplant registry to identify patients with type 1 diabetes who received a transplant between 2000 and 2021 and who survived the first 3 months following the transplant with a functioning kidney. Eligible patients were categorized as: (1) deceased-donor kidney transplant alone (DDKA); (2) living-donor kidney transplant alone (LDKA); (3) SPK recipients with a functioning pancreas graft 3 months post-transplant (SPK, P+); or (4) SPK recipients with a pancreas graft failure within 3 months post-transplant (SPK, P-).

Multivariable inverse probability of treatment weighted accelerated failure-time (AFT) models, with weights estimated using generalized boosted regression, was used to estimate associations of transplant type with kidney failure and patient survival through September 2021.

The study cohort included 22,258 patients. The AFT model coefficients were exponentiated to calculate time ratio (TR)_95%LCLTR_95%UCL, which was interpreted as the expected time to graft failure or patient death in one category relative to the referent group. Compared to the recipients in the SPK, P+ group, LDKA had 18% less graft survival time (TR:_0.730.82_0.92) and 18% less patient survival time (TR:_0.720.82_0.93), patients in the DDKA group had 23% less graft survival time (TR: _0.710.77_0.85) and 29% less patient survival time (TR: _0.640.71_0.79), and patients in the SPK,P- group had 34% less graft survival time (TR: _0.590.66_0.75) and 34% less patient survival time (TR: _0.580.66_0.75).

In summary, the authors said, “SPK recipients with functioning pancreas grafts within 3-months post-transplant have better kidney allograft and patient survival compared with LDKA and DDKA. Early pancreas graft failure results in kidney and patient survival time similar to kidney transplant alone. Our findings provide insights into the decision-making of SPK versus KA transplant options for patients and providers.”

Source: Ji M, Chang S, Wang M, et al. Three-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation in type 1 diabetes patients. Abstract of a poster presented at the 2022 American Transplant Congress (Abstract 1150), Boston, Massachusetts. June 5, 2022.