Simultaneous pancreas-kidney transplantation and living related donor renal transplantation in patients with diabetes: Is there a difference in survival?

Objective To compare the outcome of simultaneous pancreas-kidney transplantation (SPK ) and living related donor renal transplantation (LRD) in patients with dia betes. Summary Background Data It remains unanswered whether diabetic patients with endstage renal failure are better served by LRD or SPK. Methods Using a longitudinal database, data from ail diabetic patients receiving LR D or cadaveric renal transplants or SPKs from January 1986 through January 1996 were analyzed. Patient and graft survival, early graft function, and t he cause of patient and graft loss were compared for 43 HLA-identical LRDs, 87 haplotype-identical LRDs, 379 SPKs, and 296 cadaveric renal transplants . Results The demographic composition of the SPK and LRD groups were similar, but bec ause of less strict selection criteria in the cadaveric transplant group, p atients were 10 years older, more patients received dialysis, and patients had been receiving dialysis longer before transplantation. Patient survival was similar for the SPK and LRD groups but was significantly lower for the cadaveric renal transplant group. Similarly, there was no difference in gr aft survival between SPK and LRD recipients, but it was significantly lower for recipients in the cadaveric renal transplant group. Delayed graft func tion was significantly more common in the cadaveric renal transplant group. Discharge creatinine, the strongest predictor of patient and graft surviva l, was highest in the SPK group and lowest in the HLA-identical LRD group. The rate of rejection within the first year was greatest in SPK patients (7 7%), intermediate in the haplotype-identical LRD and cadaveric transplant g roups (57% and 48%, respectively), and lowest (16%) in the HLA-identical LR D group. Cardiovascular disease was the primary cause of death for all grou ps. Acute rejection, chronic rejection, and death with a functioning graft were the predominant causes of graft loss. Conclusions This study demonstrates that there was no difference in patient or graft su rvival in diabetic patients receiving LRD or SPK transplants. However, graf t and patient survival rates in dia betic recipients of cadaveric renal tra nsplants were significantly lower than in the other groups.