Simultaneous Kidney-Pancreas Transplant Outcomes Similar for Type 1 and Type 2 Diabetics

Jim Kling

May 12, 2010

May 12, 2010 (San Diego, California) — Type 2 diabetics with brittle diabetes and end-stage renal disease have similar survival rates to type 1 diabetics after receiving simultaneous kidney and pancreas transplants (SKP), according to a study presented here at the American Transplant Congress 2010.

From the Organ Procurement and Transplantation Network/United Organ Sharing Network (UNOS) database, the researchers identified adult patients receiving SKP transplants between 2000 and 2007. They stratified patients on the basis of diabetes type (1 or 2) coded as causing end-stage renal disease or end-stage pancreatic disease. They excluded SKP recipients with other known causes.

The researchers identified 6650 SKP transplant recipients, of whom 5891 had type 1 and 722 (11%) had type 2 diabetes. For type 1 and type 2 diabetes, respectively, mean pretransplant dialysis dudation was 602 days and 706 days; mean age was 40 and 46 years; 13% and 1.4% were African American; 60.7% and 68.6% were male; 10.5% and 15.7% had a plasma renin assay level above 20 ng/mL; mean body mass index was 24 kg/m2 and 25  kg/m2; 10.2% and 11.6% ahd coronary artery disease; and 7.0% and 6.5% had peripheral vascular disease.

Between the 2 cohorts, the team compared posttransplant complications, kidney and pancreas allograft failure, and patient death in the 4 years after transplantation. The researchers adjusted for various confounders.

Median follow-up time was 1326 days for type 1 and 1368 days for type 2 diabetes. Recipients with type 2 diabetes experienced more pancreas anastomosis to the bladder than recipients with type 1 diabetes (14 vs 17; P < .001). For type 1 and type 2 diabetes recipients, respectively, 7.8% and 10.8% had delayed graft function (P < .001), and 1-year combined rejection of the kidney and pancreas was 11.6% and 11.0%.

SPK transplants have been perfected in type 1 diabetics, and the outcomes are very good, but there is some controversy about the outcomes for type 2 diabetics, Marcelo Sampaio, MD, research fellow at the State University of Rio de Janeiro in Brazil, who presented the research, told Medscape Transplantation.

Overall, type 2 patients tend to do worse after SKP transplants than type 1 recipients, but this is due to confounding factors, according to the researchers. Type 2 recipients tend to be older and have more comorbidities such, as vascular disease, Dr. Sampaio pointed out.

"Since the number of patients is very small, it's difficult to adjust for all these factors. We looked at the UNOS [database] so that we could include a larger number of patients. If we address all these factors, we find no difference in outcomes," Dr. Sampaio reported.

The research is important because although type 2 diabetics comprised only about 10% of SKD recipients, there were a lot more type 2 than type 1 diabetics with end-stage renal disease, according to Dr. Sampaio.

"This burden of patients is increasing with time," he said. "You have more obesity, so more diabetes and more people with kidney failure with [type 2] diabetes. Eventually they may be dependent on insulin, and if they're dependent on insulin you can [consider] a pancreas transplant."

"If you have a patient with type 2 diabetes that has end-stage renal disease and a kidney transplant is indicated, you can offer the patient a simultaneous kidney–pancreas transplant. But you have to look at the associated conditions with this patient. If it's a very old patient, or obese patient, the patient has more risk. It doesn't matter much if [the patient has] type 1 or type 2 [diabetes] — you have to look at associated conditions to help you decide," said Dr. Sampaio.

One potential drawback of the study is that there might be some issues with using the UNOS data to accurately define type 1 and type 2 recipients, according to Peter Stock, MD, PhD, a transplant surgeon at the University of California at San Francisco, who comoderated the session. "There are significant flaws in the database," Dr. Stock told Medscape Transplantation.

The study did not receive commercial support. Dr. Sampaio and Dr. Stock have disclosed no relevant financial relationships.

American Transplant Congress (ATC) 2010: Abstract 242. Presented May 3, 2010.

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