Transplantation of the Type 1 Diabetic Patient

Abstract

Although simultaneous pancreas-kidney transplantation (SPK) is generally believed to be the treatment of choice in type 1 diabetic patients with kidney failure, there is continuing controversy whether SPK is superior to kidney transplantation alone (KTA), especially when a live donor kidney (LDK) is available. This controversy is highlighted by three recent publications authored by Young et al. (1), Weiss et al. (2), and our group (3). Analyzing data from large registries, all three studies compared kidney graft and patient survival in SPK (all from deceased organ donors) and KTA transplants, whereby the KTA grafts were from deceased (DDK) or living donors (LDK). The three studies are summarized in Table 1( bold ) with respect to data source, treatment modality, length of follow-up, and patient and kidney graft survival. Young et al. and Weiss et al. analyzed U.S. data based on the Organ Procurement and Transplantation Network/United Network for Organ Sharing and the Scientific Registry of Transplant Recipients, respectively. View this table: Table 1. Impact of glycemic control on kidney allograft and patient survival (modified from Morath and Zeier [9]) Young and colleagues found superior kidney graft and patient survival in LDK recipients as compared with SPK recipients after a maximum of 7 years of follow-up. No significant difference was found between deceased donor SPK and DDK patients with respect to kidney graft and patient survival. In contrast, analyzing the international Collaborative Transplant Study (CTS) database, which collects data from 46 countries in five continents, our group found that SPK and LDK yielded clearly superior kidney graft and patient survival as compared with DDK alone. Importantly, in the CTS analysis, patient survival beyond year 10 after transplantation in SPK recipients was significantly better than that of recipients of a LDK without a pancreas graft (hazard ratio = 0.55; P = 0.005), as demonstrated for transplants …