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Comparative Study
. 2024 Sep 19:37:13087.
doi: 10.3389/ti.2024.13087. eCollection 2024.

Analysis of Rejection, Infection and Surgical Outcomes in Type I Versus Type II Diabetic Recipients After Simultaneous Pancreas-Kidney Transplantation

Eric J Martinez #  1   2 , Phuoc H Pham #  2   3 , Jesse F Wang  2 , Lily N Stalter  4 , Bridget M Welch  2 , Glen Leverson  4 , Nicholas Marka  4 , Talal Al-Qaoud  2 , Didier Mandelbrot  5 , Sandesh Parajuli  5 , Hans W Sollinger  2 , Dixon B Kaufman  2 , Robert R Redfield 3rd  2 , Jon Scott Odorico  2
Affiliations
Comparative Study

Analysis of Rejection, Infection and Surgical Outcomes in Type I Versus Type II Diabetic Recipients After Simultaneous Pancreas-Kidney Transplantation

Eric J Martinez et al. Transpl Int. .

Abstract

Given the increasing frequency of simultaneous pancreas-kidney transplants performed in recipients with Type II diabetes and CKD, we sought to evaluate possible differences in the rates of allograft rejection, infection, and surgical complications in 298 Type I (T1D) versus 47 Type II (T2D) diabetic recipients of simultaneous pancreas-kidney transplants between 2006-2017. There were no significant differences in patient or graft survival. The risk of biopsy-proven rejection of both grafts was not significantly different between T2D and T1D recipients (HRpancreas = 1.04, p = 0.93; HRkidney = 0.96; p = 0.93). Rejection-free survival in both grafts were also not different between the two diabetes types (ppancreas = 0.57; pkidney = 0.41). T2D had a significantly lower incidence of de novo DSA at 1 year (21% vs. 39%, p = 0.02). There was no difference in T2D vs. T1D recipients regarding readmissions (HR = 0.77, p = 0.25), infections (HR = 0.77, p = 0.18), major surgical complications (HR = 0.89, p = 0.79) and thrombosis (HR = 0.92, p = 0.90). In conclusion, rejection, infections, and surgical complications after simultaneous pancreas-kidney transplant are not statistically significantly different in T2D compared to T1D recipients.

Keywords: complication; infection; pancreas-kidney transplantation; rejection; type 2 diabetes.

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Conflict of interest statement

The authors of this manuscript have conflicts of interest to disclose as described by the Transplant International. JO is co-founder of, has equity interest in and serves as Chair of the Scientific Advisory Board of Regenerative Medical Solutions, Inc. He receives clinical trial support from Veloxis Pharmaceuticals, CareDx Transplant Management, Inc., Natera, Inc. and Vertex Pharmaceuticals, Inc. DK reports serving as a scientific advisor for, or member of, eGenesis, and receiving research funding from Medeor Pharma and the National Institutes of Health. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Schematic diagram of study design and data analysis. UWHC, University of Wisconsin Hospital and Clinics; PTA, Pancreas Transplant Alone; PAK, Pancreas After Kidney (transplant); SPKT, Simultaneous Pancreas Kidney Transplant; PTA, Pancreas Transplant Alone; PAK, Pancreas After Kidney (transplant); T1D, Type 1 Diabetes Mellitus; T2D, Type 2 Diabetes Mellitus; BPR, Biopsy Proven Rejection; dnDSA, de novo Donor Specific Antibody; SSI, Surgical Site Infection.
FIGURE 2
FIGURE 2
Kaplan Meier survival estimates for patient survival (A), pancreas graft failure (B), pancreas graft rejection (C), kidney graft failure (D), kidney graft rejection (E), and de novo DSA (F).
FIGURE 3
FIGURE 3
Kaplan Meier survival estimates for readmission (A), infection (B), major surgical complications (C) and thrombosis (D).
See this image and copyright information in PMC

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