RENAL-ALLOGRAFT AND PATIENT OUTCOME AFTER TRANSPLANTATION - PANCREAS-KIDNEY VERSUS KIDNEY-ALONE TRANSPLANTS IN TYPE-1 DIABETIC-PATIENTS VERSUS KIDNEY-ALONE TRANSPLANTS IN NONDIABETIC PATIENTS

Despite recent advances and improved outcome, pancreas transplantation remains controversial. The purpose of this review was to study renal allograft outcome after simultaneous pancreas-kidney transplants (SPK, n = 61), kidney-alone transplants in type I diabetic patients (KA-D, n = 63), and kidney-alone transplants in nondiabetic patients (KA-ND, n = 80). Patients were matched for donor age, donor gender, donor race , interval from donor admission to procurement, DR mismatch, and recip ient gender. The mean renal allograft cold ischemic time and recipient age were lower in the SPK group. Patient survival was highest in the KA-ND group (99% and 86% at 1 and 5 years, respectively), intermediate in the SPK group (90% and 78% at 1 and 5 years, respectively), and lo west in the KA-D group (89% and 66% at 1 and 5 years, respectively) (P = 0.004). Similarly, renal allograft survival was higher in the KA-ND (89% and 63% at 1 and 5 years, respectively) and SPK (82% and 69% at 1 and 5 years, respectively) groups compared with the KA-D group (76% and 49% at 1 and 5 years, respectively) (P = 0.07). This difference di sappeared when renal graft survival was censored for death, which prob ably reflects the selection bias. Actuarial pancreas graft survival wa s 76% and 62% at 1 and 5 years, respectively. Acute rejection (AR) was more frequent in the SPK group than in the KA-D and KA-ND groups (41% v 16% v 29%; P = 0.007). Delayed graft function (DGF), on the other h and, occurred more frequently in the KA-D group than in the KA-ND and SPK groups (66% v 55% v 38%; P = 0.08). Death as a result of a cardiov ascular event occurred more frequently in the KA-D group. Cardiovascul ar death and renal graft failure occurred earlier in the SPK group. Co x regression analysis revealed a 1.6 and 1.8 times higher risk of rena l graft failure in the SPK group when the donor was greater than or eq ual to 40 years old or female and a five times higher risk of graft fa ilure in the KA-ND group in the presence of AR. Graft survival in pati ents with AR/DGF was lower than that in patients with no AR/no DGF in both the KA-D (71% and 63% v 100% and 100% at 1 and 5 years, respectiv ely; P = 0.03) and KA-ND (90% and 56% v 100% and 100% at 1 and 5 years , respectively; P = 0.001) groups. Acute rejection did not affect graf t survival in the SPK group. In the absence of AR, DGF had no effect o n graft survival in any of the groups. Although the selection bias in favor of pancreas transplantation does not allow for definitive conclu sions, our results show that outcome after SPK transplantation is acce ptable and factors that influence the outcome after this procedure may be different from the ones affecting KA-D recipients. (C) 1996 by the National Kidney Foundation, Inc.