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Abstract
(1) Background: Simultaneous pancreas–kidney transplantation (SPKT) is a standard therapeutic option for patients with diabetes mellitus type I and kidney failure. Early pancreas allograft failure is a complication potentially associated with worse outcomes. (2) Methods: We performed a landmark analysis to assess the impact of early pancreas graft loss within 3 months on mortality and kidney graft survival over 10 years. This retrospective single-center study included 114 adult patients who underwent an SPKT between 2005 and 2018. (3) Results: Pancreas graft survival rate was 85.1% at 3 months. The main causes of early pancreas graft loss were thrombosis (6.1%), necrosis (2.6%), and pancreatitis (2.6%). Early pancreas graft loss was not associated with reduced patient survival (p = 0.168) or major adverse cerebral or cardiovascular events over 10 years (p = 0.741) compared to patients with functioning pancreas, after 3 months. Moreover, kidney graft function (p = 0.494) and survival (p = 0.461) were not significantly influenced by early pancreas graft loss. (4) Conclusion: In this study, using the landmark analysis technique, early pancreas graft loss within 3 months did not significantly impact patient or kidney graft survival over 10 years.
Highlights
Simultaneous pancreas–kidney transplantation (SPKT) is considered the best therapeutic option for patients with diabetes mellitus type I and kidney failure [1,2]
Previous study results may be influenced by time-dependent effects, since pancreas allograft failure occurs over time
SPKT in diabetes mellitus type II patients is only allowed in strictly exceptional cases in the Eurotransplant region [21]
Summary
Simultaneous pancreas–kidney transplantation (SPKT) is considered the best therapeutic option for patients with diabetes mellitus type I and kidney failure [1,2]. Risks resulting from the surgical procedure and the lifelong immunosuppression have to be taken into account and weighed against the potential benefits. Early pancreas graft failure is still rather frequent, with an occurrence of more than 10%. The literature provides inconsistent data for its impact on various outcomes. While several studies in the past showed that early pancreas graft failure is associated with increased kidney allograft loss and worse outcomes [15,16,17,18], a very recent study reported the contrary [19]. Previous study results may be influenced by time-dependent effects, since pancreas allograft failure occurs over time.
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