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Living Donor Kidney Versus Simultaneous Pancreas-Kidney Transplant in Type I Diabetics: An Analysis of the OPTN/UNOS Database

Brian Y. Young^*, Jagbir Gill^*,, Edmund Huang, Steven K. Takemoto, Bishoy Anastasi^*, Tariq Shah, and Suphamai Bunnapradist^*

^* David Geffen School of Medicine, University of California, Los Angeles, California; St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Johns Hopkins School of Medicine, Baltimore, Maryland; National Institute of Transplantation, Los Angeles, California

Correspondence: Dr. Suphamai Bunnapradist, Department of Medicine, UCLA Medical Center, 924 Westwood Boulevard, Suite 200, Los Angeles, CA, 90095. Phone: 310-794-8516; Fax: 310-825-8589; E-mail: bunnapradist{at}mednet.ucla.edu

Background and objectives: Transplant options for type I diabetics with end-stage renal disease include simultaneous pancreas-kidney (SPKT), living donor kidney (LDKT), and deceased donor kidney transplant (DDKT). It is unclear whether SPKT offers a survival benefit over LDKT in the current era of transplantation. The authors compared outcomes of kidney transplant recipients with type I diabetes using data from the Organ Procurement and Transplant Network/United Network for Organ Sharing.

Design, setting, participants, & measurements: Adult (age 20 to 59) type I diabetics who received a solitary first-time kidney transplant between 2000 and 2007 were studied. Outcomes included overall kidney graft and patient survival. Multivariate analysis was performed using a stepwise Cox proportional hazards model.

Results: Kidney graft survival was better for recipients of LDKT compared with SPKT (P = 0.008), although patient survival was similar (P = 0.346). On multivariate analysis, LDKT was associated with lower adjusted risks over 72 mo follow-up of kidney graft failure (HR 0.71; 95% CI 0.61 to 0.83) and patient death (HR 0.78; 95% CI 0.65 to 0.94) versus SPKT. Compared with DDKT, SPKT had superior unadjusted kidney graft and patient survival, partly due to favorable SPKT donor and recipient factors.

Conclusions: Despite more transplants from older donors and among older recipients, LDKT was associated with superior outcomes compared with SPKT and was coupled with the least wait time and dialysis exposure. LDKT utilization should be considered in all type I diabetics with an available living donor, particularly given the challenges of ongoing organ shortage.

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Best Option for Transplant Candidates with Type 1 Diabetes and a Live Kidney Donor: A Bird in the Hand is Worth Two in the Bush

Peter P. Reese and Ajay K. Israni
Clin. J. Am. Soc. Nephrol. 2009 4: 700-702. [Full Text] [PDF]

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				R. Bhargava, N. Mitsides, I. Saif, P. MacDowall, and A. Woywodt C-peptide and combined kidney-pancreas transplantation NDT Plus, December 1, 2009; 2(6): 489 - 492. [Full Text] [PDF]

				P. P. Reese and A. K. Israni Best Option for Transplant Candidates with Type 1 Diabetes and a Live Kidney Donor: A Bird in the Hand is Worth Two in the Bush Clin. J. Am. Soc. Nephrol., April 1, 2009; 4(4): 700 - 702. [Full Text] [PDF]