Abstract
Purpose of Review
There is a well-defined knowledge of relative benefits of pancreas transplants to patients with respect to specific diabetic complications; however, the degree of survival advantage of a simultaneous pancreas and kidney versus kidney transplant alone in the type I diabetes mellitus patient population remains controversial.
Recent Findings
At the crux of the issue, it remains that there is no randomized, controlled study on this topic. Moreover, the information that does exist is limited by inherent selection biases despite the most robust forms of statistical analysis in order to correct for the known issues within the data. Over time, studies have restricted group analyses to try to remove some of these biases.
Summary
While there is an increase in morbidity and mortality early on with pancreas transplantation, most studies have suggested that there is probably a modestly improved long-term outcome in simultaneous kidney-pancreas over kidney transplant alone. In the absence of better data, candidate selection for kidney-pancreas transplantation should be guided towards individual needs and preferences, taking into consideration surgical risk, quality of life, potential for impact on secondary complication of diabetes, and desire to optimize outcomes.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
•• Sung RS, et al. A reassessment of the survival advantage of simultaneous kidney-pancreas versus kidney-alone transplantation. Transplantation. 2015;99(9):1900–6. The most recent analysis that attempts to remove the cohort study bias that shows a marginal benefit in pancreas transplant after 10 years.
Larsen J, Ratanasuwan T, Burkman T. Carotid intima media thickness decreases afer pancreas transplantation. Transplantation. 2002;73:936–40.
Foger B, Konigsrainer A, Palos G. Effect of pancreas transplantation on lipoprotein lipase, postprandial lipemia, and HDL cholesterol. Transplantation. 1994;58:899–904.
Israni AK, et al. Impact of simultaneous kidney-pancreas transplant and timing of transplant on kidney allograft survival. Am J Transplant. 2005;5(2):374–82.
• Kandaswamy R, et al. OPTN/SRTR 2015 annual data report: pancreas. Am J Transplant. 2017;17(S1):117–73. The most recent SRTR report for pancreas transplant.
Ojo AO, et al. The impact of simultaneous pancreas-kidney transplantation on long-term patient survival. Transplantation. 2001;71(1):82–90.
Port F, et al. Am J Transplant. 2007(7):1319–26.
Weiss AS, Smits G, Wiseman AC. Twelve-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation. Clin J Am Soc Nephrol. 2009;4(5):988–95.
Norman SP, et al. Early pancreas graft failure is associated with inferior late clinical outcomes after simultaneous kidney-pancreas transplantation. Transplantation. 2011;92(7):796–801.
Bunnapradist S. Kidney allograft and patient survival in type I diabetic recipients of cadaveric kidney alone versus simultaneous pancreas/kidney transplants: a multivariate analysis of the UNOS database. J Am Soc Nephrol. 2003;14(1):208–13.
Reddy KS, et al. Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure. Am J Kidney Dis. 2003;41(2):464–70.
Venstrom J, et al. Survival after pancreas transplantion in patients with diabetes and preserved kidney function. JAMA. 2003;290:2817–23.
Gruessner RWG, Sutherland DER, Gruessner AC. Mortality assessment for pancreas transplants. Am J Transplant. 2004;4(12):2018–26.
Sureshkumar KK, et al. Quality of life after organ transplantation in type 1 diabetics with end-stage renal disease. Clin Transpl. 2005;20:19–25.
• Morath C, et al. Response to a reassessment of the survival advantage simultaneous kidney-pancreas versus kidney-alone transplantation. Transplantation. 2015;99(11):e175. A response to the Sung et al. paper, stating that the true survival advantage of pancreas transplant is between the 11–20-year mark.
Redfield RR, et al. Simultaneous pancreas and kidney transplantation: current trends and future directions. Current Opinions in Organ Transplantation. 2015;20(1):94–102.
Marroquin CE, et al. Half-life analysis of pancreas and kidney transplants. Transplantation. 2005;80(2):272–5.
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Randall Sung and Derrick Christopher declare no conflict of interest.
Derrick Christopher participated in review compilation and writing of the paper. Randall Sung participated in review compilation and writing of the paper.
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This article does not contain any studies with human or animal subjects performed by any of the authors.
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This article is part of the Topical Collection on Pancreas Transplantation
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Christopher, D.A., Sung, R.S. Survival Advantage of Kidney-Pancreas vs. Kidney Alone Transplant in the Modern Era. Curr Transpl Rep 4, 129–134 (2017). https://doi.org/10.1007/s40472-017-0151-z
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DOI: https://doi.org/10.1007/s40472-017-0151-z