WASHINGTON, DC -- May 21, 2008 -- For patients with type 1 diabetes and end-stage renal disease (ESRD), simultaneous kidney-pancreas transplantation increases the chances of long-term survival compared with kidney transplantation alone, reports a study in the August issue of the Journal of the American Society of Nephrology.
"Based on these results, we feel that all type 1 diabetics with kidney failure should be considered for simultaneous pancreas-kidney transplantation," comments Christian Morath, MD, Department of Nephrology, University of Heidelberg, Heidelberg, Germany.
Dr. Morath and colleagues analysed the long-term outcomes of more than 11,000 patients with type 1 diabetes and ESRD who received a kidney transplant between 1984 and 2000. About 3,500 patients underwent simultaneous transplantation of the pancreas and kidney from a deceased donor. The remaining patients received a kidney only, from either a living or deceased donor.
Patient survival and survival of the transplanted kidney were evaluated after up to 18 years of follow-up.
Both patient and kidney survival were better for patients undergoing pancreas-kidney transplant or living-donor kidney transplant compared with deceased-donor kidney transplant. At first, kidney survival rates were best for patients who received living-donor kidney transplants. However, by the end of the follow-up period, kidney survival rates were essentially the same for the pancreas-kidney and living-donor kidney groups.
When adjusted for other factors, patients receiving simultaneous pancreas-kidney transplants had better long-term survival. Beyond 10 years, the risk of death was 45% lower in the pancreas-kidney group than in the living-donor kidney group. The gain in survival with pancreas-kidney transplantation largely reflected a lower risk of death from cardiovascular disease: 37%, compared with 46% to 49% in patients receiving kidney transplants only.
"Our study shows that a functioning pancreas has a benefit for the simultaneously transplanted kidney," says Dr. Morath. "At the same time, this procedure prolongs the survival of the patient compared with a patient who received only a kidney transplant."
The improvement in survival appears to result from a lower rate of cardiovascular deaths in patients undergoing pancreas-kidney transplantation. "The reduced cardiovascular mortality is most likely due to the normoglycaemia in patients who received a combined transplant," adds Dr. Morath. "The results show an interaction of different and independent organs -- kidney, pancreas, and heart -- with respect to survival of the patient."
Given the long-term improvement in survival, combined pancreas-kidney transplantation should be considered in every patient with type 1 diabetes and ESRD, Dr. Morath and colleagues believe. "In addition, research should focus on methods which are able to normalise blood glucose levels in type 1 diabetic patients, such as islet cell transplantation."
SOURCE: Journal of the American Society of Nephrology
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