Transplant Surgery Fellow
University of Wisconsin
The Survival Benefit of Donation After Cardiac Death Simultaneous Pancreas-Kidney Transplantation in Type 1 Diabetics
Robert Redfield1, Joseph R Scalea1, Jon S Odorico1, Dixon B Kaufman1, Hans W Sollinger1, Luis A Fernandez1.
1Transplant Surgery, University of Wisconsin, Madison, WI, United States
Background: Simultaneous pancreas-kidney transplantation (SPK) has been shown to improve long term survival of uremic type 1 diabetics compared to solitary deceased donor kidney transplantation. However, it is unclear if this survival benefit applies to both donation after cardiac death donors (DCD) and brain dead donors (DBD). Additionally, it is unknown if SPK transplantation (both DCD and DBD) confers a survival advantage to the kidney allograft when compared to type 1 diabetics of kidney transplant alone for both types of donors.
Methods: This is a single center retrospective study of SPK and solitary kidney transplants performed between 1994 and 2011 in uremic type 1 diabetics at the University of Wisconsin.
Results: 931 type 1 diabetics underwent an SPK or kidney alone (KA) transplant during the study period. 702 were DBD SPK, 72 were DCD SPK, 135 DBD KA and 22 were DCD KA. SPK recipients were younger in both the DBD and DCD patients compared to DBD and DCD KA patients (39.5±7.1, 39.9±7.5, 47.2±10.2, 49.9±10.9, p<0.001). Kidney graft survival and patient survival for DCD and DBD SPK were similar, and superior, to DCD and DBD KA (p<0.001). In a multivariate analysis controlling for donor characteristics (KDRI) and recipient characteristics (age, race, dialysis status) as well delayed graft function, rates of rejection and transplant era confirmed the similar graft and patient survival between DBD and DCD SPK recipients. DBD KA and DCD KA recipients had an increased risk of death (HR 2.250, 1.966-2.534, p=0.004 and 2.497, 2.105-2.889, p=0.020, respectively) and graft loss (HR 2.021, 1.781-2.261, p=0.004 and HR 2.686, 2.339-3.033, p=0.004, respectively) compared to DCD SPK.
Conclusions: DCD SPK offers a comparable patient and graft survival to DBD SPK and is superior to both DBD and DCD KA graft and patient survival.
15:30 - 17:00
|Pancreas & Islet Donors: Assessing Risk and Optimizing Outcomes||The Survival Benefit of Donation After Cardiac Death Simultaneous Pancreas-Kidney Transplantation in Type 1 Diabetics||Room 110|
15:30 - 17:00
|Pancreas and Islet Transplantation: Antibodies, Immunosuppression, and Outcomes||Incidence, Outcomes and Predictors of de novo Donor Specific Antibody in Pancreas Transplantation||Room 110|