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. 2019 Jul 23;5(8):e473.
doi: 10.1097/TXD.0000000000000919. eCollection 2019 Aug.

Pancreas Retransplant After Pancreas Graft Failure in Simultaneous Pancreas-kidney Transplants Is Associated With Better Kidney Graft Survival

Sandesh Parajuli  1 , Annamalai Arunachalam  1 , Kurtis J Swanson  1 , Fahad Aziz  1 , Neetika Garg  1 , Natalie Bath  2 , Robert R Redfield  2 , Dixon Kaufman  2 , Arjang Djamali  1   2 , Jon Odorico  2 , Didier A Mandelbrot  1
Affiliations

Pancreas Retransplant After Pancreas Graft Failure in Simultaneous Pancreas-kidney Transplants Is Associated With Better Kidney Graft Survival

Sandesh Parajuli et al. Transplant Direct. .

Abstract

Background: Simultaneous pancreas-kidney (SPK) transplant is usually the best option for the diabetic end-stage renal disease patient. There is limited information about kidney graft outcomes in SPK recipients with isolated pancreas graft failure who do versus do not undergo pancreas retransplantation.

Methods: Patients were divided into 2 groups based on whether they underwent pancreas retransplant (ReTx+) or not (ReTx-). Kidney graft function and survival were the primary endpoints.

Results: One hundred and nine patients satisfied our selection criteria, 25 in ReTx+ and 84 in ReTx-. Mean interval from SPK to pancreas failure was significantly shorter in the ReTx+ compared with the ReTx- group, 19.3 ± 36.7 versus 45.7 ± 47.0 months (P = 0.01), respectively. There was no significant difference in kidney graft follow-up post SPK between 2 groups (P = 0.48). At last follow-up, 15 of the 25 (60%) of the repeat pancreas graft had failed, with a mean graft survival among these failed pancreas graft of 2.6 ± 2.7 years, ranging from 0 to 8.1 years. Uncensored kidney graft failure was significantly lower in the ReTx+ group compared with the ReTx- group, 44% versus 67% (P = 0.04). Death-censored kidney graft failure was also lower in the ReTx+ group, 24% versus 48% (P = 0.04). The difference in patient survival did not reach statistical significance. In adjusted Cox regression analysis, rejection as a cause of pancreas failure was associated with increased risk of death-censored kidney graft failure, and pancreas retransplantation was associated with decreased risk of kidney graft failure. A similar pattern was seen after 1:1 matching for the interval between SPK and pancreas graft failure.

Conclusions: Even though ReTx+ patients accept the risks associated with repeat pancreas surgery, providers should consider this option in suitable otherwise healthy patients.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Study design among SPK recipients transplanted between 2000 and 2016. SPK, simultaneous pancreas-kidney.
FIGURE 2.
FIGURE 2.
Kidney graft survival after pancreas graft failure in SPK recipients stratified by whether the patient underwent pancreas retransplantation (uncensored or death censored). SPK, simultaneous pancreas-kidney.
FIGURE 3.
FIGURE 3.
Patient survival after pancreas graft failure comparing pancreas retransplantation to no pancreas retransplantation.
FIGURE 4.
FIGURE 4.
Kidney graft survival after pancreas graft failure in SPK recipients 1:1 matched for the interval between SPK transplant and graft failure stratified by presence or absence of pancreas retransplantation (uncensored or death censored). SPK, simultaneous pancreas-kidney.
See this image and copyright information in PMC

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