Preemptive simultaneous pancreas kidney transplantation has survival benefit to patient

• Published in: Kidney international
• Main Authors: Montagud-Marrahi, Enrique, Cuadrado-Payán, Elena, Hermida, Evelyn, Cacho, Judit, Cucchiari, David, Revuelta, Ignacio, Del Risco-Zevallos, Jimena, Esforzado, Nuria, Cofan, Frederic, Oppenheimer, Federic, Torregrosa, Vicens, Ferrer, Joana, Amor, Antoni J, Esmatjes, Enric, Ramírez-Bajo, Maria José, Musquera, Mireia, Cooper, Mathew, Bayes, Beatriu, Campistol, Josep M, Diekmann, Fritz, Ventura-Aguiar, Pedro
• Format: Journal Article
• Language: English
• Published: United States 26.05.2022
• Subjects: dialysis; simultaneous pancreas-kidney transplantation; preemptive transplantation; kidney transplantation; pancreas transplantation
• ISSN: 1523-1755

Several organ allocation protocols give priority to waitlisted simultaneous kidney-pancreas (SPK) transplant recipients to mitigate the higher cardiovascular risk of patients with diabetes mellitus on dialysis. The available information regarding the impact of preemptive simultaneous kidney-pancreas transplantation on recipient and grafts outcomes is nonetheless controversial. To help resolve this, we explored the influence of preemptive simultaneous kidney-pancreas transplants on patient and graft survival through a retrospective analysis of the OPTN/UNOS database, encompassing 9690 simultaneous transplant recipients between 2000 and 2017. Statistical analysis was performed applying a propensity score analysis to minimize bias. Of these patients 1796 (19%) were transplanted preemptively. At ten years recipient survival was significantly superior in the preemptive group when compared to the non-preemptive group (78.9% vs 71.8%). Dialysis at simultaneous kidney-pancreas transplantation was an independent significant risk for patient survival (hazard ratio 1.66 [95% confidence interval 1.32-2.09]), especially if the dialysis duration was 12 months or longer. Preemptive transplantation was also associated with significant superior kidney graft survival compared to those on dialysis (death-censored: 84.3% vs 75.4%, respectively; estimated half-life of 38.57 [38.33 -38.81] vs 22.35 [22.17 - 22.53] years, respectively). No differences were observed between both groups neither for pancreas graft survival nor for post-transplant surgical complications. Thus, our results sustain the relevance of early referral for pancreas transplantation and the importance of pancreas allocation priority in reducing patient mortality after simultaneous kidney-pancreas transplantation.