Cardiovascular Benefits of Simultaneous Pancreas–Kidney Transplant Versus Kidney Alone Transplant in Diabetic Patients

Abstract

The aim of our study was to demonstrate the cardiovascular benefits of simultaneous pancreas–kidney transplantation when compared to kidney-alone transplants in diabetic recipients. Patients and methods A total of 386 renal transplants were performed from 1985 to 2004, including 262 (68%) in diabetic recipients and 124 (32%) in nondiabetics. Among the former group, 200 kidneys were transplanted simultaneously to the pancreatic graft (KP group) and 62 were kidney-alone transplants (KA group). The mean time on dialysis was 31 ± 20 months (range 0–126 months). The duration of diabetes was 24 ± 7 years (range 5–51 years). Ninety-nine percent of the patients were on renal replacement therapy (79% on hemodialysis and 20% on peritoneal dialysis). Results Among 262 patients, 28 (11%) died due to a cardiovascular event, which was higher among KA patients compared with the KP group ( P = .004). Overall patient survival was significantly higher in the KP group when compared with the KA group (log-rank: P = .0004). Patient survivals were 80% and 70% versus 70% and 40% at 5 and 10 years in the KP and KA groups, respectively. Kidney graft survivals were 81% and 60% versus 63% and 26% at 5 and 10 years in the KP and KA groups, respectively. Pancreas graft survival was 70% and 50% at 5 and 10 years, respectively. Conclusions This clinical evaluation, even if retrospective, confirmed that simultaneous pancreas–kidney transplantation has a protective effect against cardiovascular mortality in diabetic recipients affected by end-stage renal disease.