COMMENTARY

Kidney and Pancreas Transplants: Do Sequential Procedures Improve Survival?

Ron Shapiro, MD

Disclosures

August 16, 2010

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Hi, my name is Ron Shapiro. I'm a transplant surgeon at the University of Pittsburgh. Today, I want to talk to you about a very interesting analysis of the UNOS [United Network for Organ Sharing] database looking at patients who are diabetic and undergo either combined kidney-pancreas transplantation or undergo a pancreas transplant after a living-donor kidney transplant. Combined or staged kidney-pancreas transplantations are both options for patients with end-stage renal disease secondary to diabetes who would like to have a kidney transplant and would also like to have a pancreas transplant and get off insulin.

The analysis suggested that patients who underwent pancreas transplantation after living-donor kidney transplantation had both better patient survival and better kidney allograft survival than the patients who underwent simultaneous kidney-pancreas transplantation. Pancreas graft survival in the pancreas after a living-donor kidney transplant was inferior, perhaps related to the fact that one cannot use the kidney to follow the pancreas. But overall, kidney allograft survival was improved in this group.

This suggests that there are a number of reasonable options for patients who want to undergo kidney and pancreas transplantation and that there are potential advantages and also disadvantages in those patients who receive a living-donor kidney, with a pancreas after kidney. Thank you.

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