PANCREAS TRANSPLANT IN CHRONIC KIDNEY DISEASE FOR TYPE 1 DIABETIC PATIENTS

Abstract

Background: Although both pancreas transplantation alone (PTA) and islet cell transplantation (ICT) have been associated with peri-operative declines in eGFR, the magnitude of decline is far less than that associated with medically managed (MM) diabetes. In the long term, PTA and ICT have demonstrated stabilization of chronic kidney disease (CKD) for type 1 diabetic patients. In this setting, it remains unclear whether transplantation reduces future need for kidney transplantation and mortality. Methods: A decision analytic Markov state transition model was created to simulate the life of type 1 diabetic patients with CKD who underwent one of three interventions: 1) PTA, 2) ICT, or 3) MM. Estimated declines in eGFR, chance of requiring kidney transplant, and mortality were estimated following each intervention for a simulated cohort of 3,000 patients. Base case patients were defined as 30 year old type 1 diabetic patients with an initial eGFR of 30 ml/min/1.732. Sensitivity analysis of initial eGFR was performed. Markov model parameters were extracted from literature review (1-4). Results: PTA and ICT was associated with improved long-term survival across a spectrum of initial eGRF (15-60 ml/min/1.732). For base case patients, ICT patients required few transplants, and gained 17.8 years of life compared to MM patients, and 3.8 years of life compared to PTA patients. Conclusion: ICT is associated with stabilization of eGFR, thereby reducing need to future kidney transplantation and improving long-term survival.