Faculty Collaboration Database

The impact of pre-transplant dialysis on simultaneous pancreas-kidney versus living donor kidney transplant outcomes. Nephrol Dial Transplant 2013 Apr;28(4):1047-58

Date

01/29/2013

Pubmed ID

23355627

DOI

10.1093/ndt/gfs582

Scopus ID

2-s2.0-84876010283 (requires institutional sign-in at Scopus site)   20 Citations

Abstract

BACKGROUND: Pre-transplant dialysis is known to affect kidney graft survival. Here, we report the impact of pre-transplant dialysis on patient and graft survival of type 1 diabetic recipients of either a simultaneous pancreas-kidney (SPK) or living donor kidney (LDK) transplant.

METHODS: Using the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database, 6822 adult type 1 diabetic recipients transplanted through 2000-2011 were identified. Patients were categorized based on pre-transplant dialysis time (DT): preemptive recipients (P-LDK, n = 498; P-SPK, n = 1529), recipients with <1 year of DT (0-1 year DT; LDK n = 582, SPK n = 1700), and those with 1-2 years DT (1-2 year DT; LDK n = 301, SPK n = 2212). Seven-year patient and kidney survival were examined.

RESULTS: Compared with the P-SPK group, both 0-1 year DT and 1-2 year DT SPK recipients had lower 7-year patient survival (89, 84 & 84% respectively; log-rank P-value versus P-SPK = 0.01 & <0.001). For LDK groups, DT > 1 year was associated with inferior patient survival (7-year survival 76% versus 87% for P-LDK, P-value versus P-LDK = 0.009). Comparing P-LDK to all other SPK groups, there was no significant difference in 7-year patient or kidney survival.

CONCLUSIONS: Preemptive transplantation is associated with the highest patient survival in both LDK and SPK. Compared with the P-LDK group, DT > 1 year is associated with lower patient survival among LDK recipients, but there is no difference in survival with dialysis up to 2 years with SPK. These results highlight the differential impact of DT on LDK and SPK transplantation.

Author List

Wiseman AC, Huang E, Kamgar M, Bunnapradist S

Author

Mandana Kamgar MD Assistant Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Diabetes Mellitus, Type 1
Female
Follow-Up Studies
Graft Survival
Humans
Kidney Transplantation
Living Donors
Male
Middle Aged
Pancreas Transplantation
Prognosis
Renal Dialysis
Retrospective Studies
Survival Rate
Tissue and Organ Procurement