Simultaneous pancreas-kidney (SPK) transplantation offers no patient or survival advantage over deceased-donor kidney transplantation alone (DDKA) for selected patients with type 2 diabetes, new findings suggest.
Alexander C. Wiseman, MD, and Jane Gralla, MD, of the University of Colorado Denver in Aurora, analyzed data from 6,416 transplant recipients with type 2 diabetes. To be included in the study, patients had to have a body mass index of 18-30 kg/m2 and younger than 60 years. Of the 6,416 recipients, 4,005, 1,987, and 424 underwent DDKA, living-kidney transplantation alone (LDKA), and SPK, respectively. They looked at patient and graft survival out to five years.
The five-year patient survival rate was higher in the SPK than the DDKA group (82% vs. 75.5%), but the survival advantage was related to younger donor and recipients ages in the SPK group rather than pancreas transplantation, the investigators, the researchers reported in the Clinical Journal of the American Society of Nephrology (2012;7:656-664). The five-year death-censored graft survival was 86.2% and 82.6% in the SPK and DDKA recipients, respectively, a nonsignificant difference between the groups.
Multivariate analysis revealed no significant difference in patient and death-censored graft survival between DDKA and SPK recipients. LDKA patients, however, had significantly better patient and death-censored graft survival than the SPK group. Compared with SPK recipients, the LDKA group had a 50% decreased risk of death and a 34% decreased risk of graft loss.
The authors noted that the United Network for Organ Sharing amended its organ allocation policy to expedite SPK transplantation. “Patients who are waitlisted for SPK are now given allocation priority over other patients awaiting a kidney transplant when a deceased kidney-pancreas donor is identified,” they observed.
Drs. Wiseman and Gralla, however, pointed out that although their findings support the judicious use of SPK in selected patients with type 2 diabetes who do not have a living kidney donor available, “caution must be used before a generalized expansion of this treatment option can be considered” for type 2 diabetics.
Expansion the use of SPK among type 2 diabetics would reduce the number of available pancreases and decrease the number of SPK procedures for type 1 diabetics, a group for which previous studies have clearly demonstrated superior outcomes for SPK over DDKA, the researchers stated.