ASSESSMENT OF FUNCTION AND SURVIVAL AS MEASURES OF RENAL GRAFT OUTCOME FOLLOWING KIDNEY AND KIDNEY-PANCREAS TRANSPLANTATION IN TYPE-I DIABETICS

Reports on renal graft outcome after kidney-alone (KA) and simultaneou s pancreas-kidney (SPK) transplants have focused on graft survival ins tead of function. The aim of this study is to compare renal graft outc ome after KA and SPK using graft function and survival as the measures of outcome. The records of 102 transplants performed in type I diabet ics from 10/90 to 9/96 were reviewed (SPK 42, KA 60). Serum creatinine (Cr) and calculated glomerular filtration rate (GFR) were used as est imates of graft function. Cr were similar in SPK and KA on day 3 (4.8 +/- 2.9 vs. 4.8 +/- 2.8 mg/dl, P = 0.9) and day 7 (2.5 +/- 1.8 vs. 3.0 +/- 2.5 mg/dl, P = 0.3). GFR was higher KA at 6 months (57 +/- 18 vs. 51 +/- 12 ml/min, P = 0.08), 1 yr (55 +/- 23 vs. 51 +/- 11 ml/min, P = 0.4) and 3 yr (60 +/- 22 vs. 42 +/- 16 ml/min, P = 0.03). Kidney gra ft survival was similar in KA and SPK at 1 and 5 yr (87% vs. 89% and 4 4% vs. 47%, P = 0.8). Immunologic failure of the renal graft occurred more frequently in SPK (58% vs. 48%, P = 0.04) whereas death with func tion was more common in KA (33% vs. 17%, P = 0.04). In KA, risk factor s for failure of the renal graft included acute rejection (P = 0.008, relative risk or rr = 3.4) and African American recipient (P = 0.06, r r = 2.8). In SPK, risk factors included donor age > 40 yr (P = 0.05, r r = 5.3) and African American donor (P = 0.03, rr = 4.5). Logistic reg ression analysis revealed the following risk factors for GFR < 50 ml/m in at 1 yr: acute rejection (P = 0.03, rr = 2.2) and Cr > 3 mg/dl on d ay 7 (P = 0.06, rr = 2.3). In conclusion, although renal graft surviva l was similar after KA and SPK, better graft function was observed in KA at 3 yr. Assessment of renal graft function allows us to evaluate o utcome from a different perspective than graft survival, and these two measures of outcome complement each other.