Kidney Pancreas Transplantation

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Dinesh Ranjan - One of the best experts on this subject based on the ideXlab platform.

  • atypical etiology of massive gastrointestinal bleeding arterio enteric fistula following enteric drained Pancreas transplant
    American Surgeon, 2004
    Co-Authors: Nicholas Lopez, Dinesh Ranjan, Hoonbae Jeon, Thomas D Johnston
    Abstract:

    Pancreas Transplantation is an established treatment for selected type I insulin-dependent diabetes mellitus (DM). Increasingly, enteric drainage of exocrine secretions has been performed in preference to bladder drainage. We present two cases of massive gastrointestinal hemorrhage (GIH) related to arterial-graft duodenal fistulas, a rare cause of massive bleeding. Case 1 DM is a 49-year-old male who underwent simultaneous Kidney Pancreas Transplantation (SPK) for DM and end-stage renal disease (ESRD). He developed a transplant duodenal stump leak that resolved with drainage. He presented with massive hemorrhage at 2 months. Angiography revealed a fistula between the graft-recipient arterial anastomosis and the stump leak. This was managed by transplant pancreatectomy. Case 2 SB is a 37-year-old male who underwent Pancreas-after-Kidney Transplantation (PAK) for type I DM. At 6 months, the Pancreas graft failed due to chronic rejection. He presented 9 months later with massive hemorrhage. Upper and lower endoscopy were inconclusive. Angiography revealed a fistula between the transplant arterial graft and the transplant duodenum. This was initially managed by coil embolization and definitively by transplant pancreatectomy. Patients with functional or nonfunctional Pancreas transplants presenting with massive GIH not readily localized by endoscopy should undergo angiography to exclude this unusual etiology.

  • impact of acute rejection episodes on long term graft survival following simultaneous Kidney Pancreas Transplantation
    American Journal of Transplantation, 2003
    Co-Authors: Sudhakar K Reddy, Thomas D Johnston, Thomas Waid, Bruce A Lucas, Darcy Davies, Debra Ormond, Sony Tuteja, J W Mckeown, Dinesh Ranjan
    Abstract:

    Although it is well established that acute rejection is one of the major risk factors for chronic graft loss following Kidney Transplantation, its effect on long-term graft survival following simultaneous Kidney-Pancreas transplants (SKPTs) is less well known. We analyzed a large cohort of SKPTs and cadaver Kidney transplants reported to the United Network for Organ Sharing database during 1988–97, to determine the impact of acute rejection episodes on long-term Kidney and Pancreas graft survival. Only patients whose Kidney and Pancreas grafts had survived for at least 1 year were included. Other potential risk factors influencing long-term graft survival were included in the analysis. Of the 4251 SKPTs, 45% had no acute rejection, 36% had Kidney only rejection, 3% had Pancreas only rejection, and 16% had both Kidney and Pancreas rejection within the 1st year post transplant. The 5-year Kidney and Pancreas graft survival rates adjusted for other risk factors were 91% and 85%, respectively; for those with no acute rejection episodes, 88% and 84%, respectively; for those with Kidney only rejection, 94% and 83%, respectively; for those with Pancreas only rejection; and 86% and 78%, respectively, for those with both Kidney and Pancreas rejection. The relative risk (RR) of Kidney graft failure was 1.32 when acute rejection involved the Kidney graft only, while the RR was 1.53 when the rejection involved both organs. We conclude that acute rejection episodes have a negative impact on the long-term Kidney graft survival in the SKPT population similar to that in the cadaver Kidney transplant population. Patients who had acute rejection episodes of both Kidney and Pancreas have the worst long-term graft survival.

  • long term survival following simultaneous Kidney Pancreas Transplantation versus Kidney Transplantation alone in patients with type 1 diabetes mellitus and renal failure
    American Journal of Kidney Diseases, 2003
    Co-Authors: Sudhakar K Reddy, Don Stablein, S Taranto, Robert J Stratta, Thomas D Johnston, Thomas Waid, Wade J Mckeown, Bruce A Lucas, Dinesh Ranjan
    Abstract:

    Abstract Background: Pancreas Transplantation improves quality of life and prevents the progression of secondary complications of diabetes. Whether these benefits translate into a long-term survival advantage is not entirely clear. Methods: Using the United Network for Organ Sharing database, we analyzed long-term survival in 18,549 patients with type 1 diabetes and renal failure who received a Kidney transplant between 1987 and 1996. Patient survival was calculated using the Kaplan-Meier method. Proportional hazards models were used to adjust for effects of differences in recipient and donor variables between simultaneous Kidney-Pancreas transplants (SKPTs) and Kidney-alone transplants. Results: SKPT and living donor Kidney recipients had a significant crude survival distribution advantage over cadaver Kidney transplant recipients (8-year survival rates: 72% for SKPT recipients, 72% for living donor Kidney recipients, and 55% for cadaver Kidney recipients). The survival advantage for SKPT recipients over cadaver Kidney recipients diminished, but persisted after adjusting for donor and recipient variables and Kidney graft function as time-varying covariates. SKPT recipients had a high mortality risk relative to living donor Kidney recipients through 18 months postTransplantation (hazards ratio, 2.2; P

Thomas D Johnston - One of the best experts on this subject based on the ideXlab platform.

  • atypical etiology of massive gastrointestinal bleeding arterio enteric fistula following enteric drained Pancreas transplant
    American Surgeon, 2004
    Co-Authors: Nicholas Lopez, Dinesh Ranjan, Hoonbae Jeon, Thomas D Johnston
    Abstract:

    Pancreas Transplantation is an established treatment for selected type I insulin-dependent diabetes mellitus (DM). Increasingly, enteric drainage of exocrine secretions has been performed in preference to bladder drainage. We present two cases of massive gastrointestinal hemorrhage (GIH) related to arterial-graft duodenal fistulas, a rare cause of massive bleeding. Case 1 DM is a 49-year-old male who underwent simultaneous Kidney Pancreas Transplantation (SPK) for DM and end-stage renal disease (ESRD). He developed a transplant duodenal stump leak that resolved with drainage. He presented with massive hemorrhage at 2 months. Angiography revealed a fistula between the graft-recipient arterial anastomosis and the stump leak. This was managed by transplant pancreatectomy. Case 2 SB is a 37-year-old male who underwent Pancreas-after-Kidney Transplantation (PAK) for type I DM. At 6 months, the Pancreas graft failed due to chronic rejection. He presented 9 months later with massive hemorrhage. Upper and lower endoscopy were inconclusive. Angiography revealed a fistula between the transplant arterial graft and the transplant duodenum. This was initially managed by coil embolization and definitively by transplant pancreatectomy. Patients with functional or nonfunctional Pancreas transplants presenting with massive GIH not readily localized by endoscopy should undergo angiography to exclude this unusual etiology.

  • impact of acute rejection episodes on long term graft survival following simultaneous Kidney Pancreas Transplantation
    American Journal of Transplantation, 2003
    Co-Authors: Sudhakar K Reddy, Thomas D Johnston, Thomas Waid, Bruce A Lucas, Darcy Davies, Debra Ormond, Sony Tuteja, J W Mckeown, Dinesh Ranjan
    Abstract:

    Although it is well established that acute rejection is one of the major risk factors for chronic graft loss following Kidney Transplantation, its effect on long-term graft survival following simultaneous Kidney-Pancreas transplants (SKPTs) is less well known. We analyzed a large cohort of SKPTs and cadaver Kidney transplants reported to the United Network for Organ Sharing database during 1988–97, to determine the impact of acute rejection episodes on long-term Kidney and Pancreas graft survival. Only patients whose Kidney and Pancreas grafts had survived for at least 1 year were included. Other potential risk factors influencing long-term graft survival were included in the analysis. Of the 4251 SKPTs, 45% had no acute rejection, 36% had Kidney only rejection, 3% had Pancreas only rejection, and 16% had both Kidney and Pancreas rejection within the 1st year post transplant. The 5-year Kidney and Pancreas graft survival rates adjusted for other risk factors were 91% and 85%, respectively; for those with no acute rejection episodes, 88% and 84%, respectively; for those with Kidney only rejection, 94% and 83%, respectively; for those with Pancreas only rejection; and 86% and 78%, respectively, for those with both Kidney and Pancreas rejection. The relative risk (RR) of Kidney graft failure was 1.32 when acute rejection involved the Kidney graft only, while the RR was 1.53 when the rejection involved both organs. We conclude that acute rejection episodes have a negative impact on the long-term Kidney graft survival in the SKPT population similar to that in the cadaver Kidney transplant population. Patients who had acute rejection episodes of both Kidney and Pancreas have the worst long-term graft survival.

  • long term survival following simultaneous Kidney Pancreas Transplantation versus Kidney Transplantation alone in patients with type 1 diabetes mellitus and renal failure
    American Journal of Kidney Diseases, 2003
    Co-Authors: Sudhakar K Reddy, Don Stablein, S Taranto, Robert J Stratta, Thomas D Johnston, Thomas Waid, Wade J Mckeown, Bruce A Lucas, Dinesh Ranjan
    Abstract:

    Abstract Background: Pancreas Transplantation improves quality of life and prevents the progression of secondary complications of diabetes. Whether these benefits translate into a long-term survival advantage is not entirely clear. Methods: Using the United Network for Organ Sharing database, we analyzed long-term survival in 18,549 patients with type 1 diabetes and renal failure who received a Kidney transplant between 1987 and 1996. Patient survival was calculated using the Kaplan-Meier method. Proportional hazards models were used to adjust for effects of differences in recipient and donor variables between simultaneous Kidney-Pancreas transplants (SKPTs) and Kidney-alone transplants. Results: SKPT and living donor Kidney recipients had a significant crude survival distribution advantage over cadaver Kidney transplant recipients (8-year survival rates: 72% for SKPT recipients, 72% for living donor Kidney recipients, and 55% for cadaver Kidney recipients). The survival advantage for SKPT recipients over cadaver Kidney recipients diminished, but persisted after adjusting for donor and recipient variables and Kidney graft function as time-varying covariates. SKPT recipients had a high mortality risk relative to living donor Kidney recipients through 18 months postTransplantation (hazards ratio, 2.2; P

Paolo Fiorina - One of the best experts on this subject based on the ideXlab platform.

  • near normalization of metabolic and functional features of the central nervous system in type 1 diabetic patients with end stage renal disease after Kidney Pancreas Transplantation
    Diabetes Care, 2012
    Co-Authors: Paolo Fiorina, Francesca Daddio, Chiara Gremizzi, Paolo Vezzulli, Roberto Bassi, Monica Falautano, Andrea Vergani, Lola Chabtini, Erica Altamura, Alessandra Mello
    Abstract:

    OBJECTIVE The pathogenesis of brain disorders in type 1 diabetes (T1D) is multifactorial and involves the adverse effects of chronic hyperglycemia and of recurrent hypoglycemia. Kidney-Pancreas (KP), but not Kidney alone (KD), Transplantation is associated with sustained normoglycemia, improvement in quality of life, and reduction of morbidity/mortality in diabetic patients with end-stage renal disease (ESRD). RESEARCH DESIGN AND METHODS The aim of our study was to evaluate with magnetic resonance imaging and nuclear magnetic resonance spectroscopy ( 1 H MRS) the cerebral morphology and metabolism of 15 ESRD plus T1D patients, 23 patients with ESRD plus T1D after KD ( n = 9) and KP ( n = 14) Transplantation, and 8 age-matched control subjects. RESULTS Magnetic resonance imaging showed a higher prevalence of cerebrovascular disease in ESRD plus T1D patients (53% [95% CI 36–69]) compared with healthy subjects (25% [3–6], P = 0.04). Brain 1 H MRS showed lower levels of N -acetyl aspartate (NAA)-to-choline ratio in ESRD plus T1D, KD, and KP patients compared with control subjects (control subjects vs. all, P - to-creatine ratio in ESRD plus T1D compared with KP and control subjects (ESRD plus T1D vs. control and KP subjects, P ≤ 0.01). The evaluation of the most common scores of psychological and neuropsychological function showed a generally better intellectual profile in control and KP subjects compared with ESRD plus T1D and KD patients. CONCLUSIONS Diabetes and ESRD are associated with a precocious form of brain impairment, chronic cerebrovascular disease, and cognitive decline. In KP-transplanted patients, most of these features appeared to be near normalized after a 5-year follow-up period of sustained normoglycemia.

  • altered Kidney graft high energy phosphate metabolism in Kidney transplanted end stage renal disease type 1 diabetic patients a cross sectional analysis of the effect of Kidney alone and Kidney Pancreas Transplantation
    Diabetes Care, 2007
    Co-Authors: Paolo Fiorina, Antonio Secchi, Livio Luzi, Chiara Gremizzi, Gianluca Perseghin, Francesco De Cobelli, Alessandra Petrelli, L D Monti, Paola Maffi, Alessandro Del Maschio
    Abstract:

    OBJECTIVE —Diabetes, hypertension, dyslipidemia, obesity, nephrotoxicity of certain immunosuppressive drugs, and the persistence of a chronic alloimmune response may significantly affect graft survival in end-stage renal disease (ESRD) type 1 diabetic patients who have undergone Kidney transplant. The aim of this study was to ascertain the impact of Kidney alone (KD) or combined Kidney-Pancreas (KP) Transplantation on renal energy metabolism. RESEARCH DESIGN AND METHODS —We assessed high-energy phosphates (HEPs) metabolism by using, in a cross-sectional fashion, 31 P-magnetic resonance spectroscopy in the graft of ESRD type 1 diabetic transplanted patients who received KD ( n = 20) or KP ( n = 20) transplant long before the appearance of overt chronic allograft nephropathy (CAN). Ten nondiabetic microalbuminuric Kidney transplanted patients and 10 nondiabetic Kidney transplanted patients with overt CAN were chosen as controls subjects. RESULTS —Simultaneous KP Transplantation patients showed a higher β-ATP/inorganic phosphorus (Pi) ratio (marker of the graft energy status) versus the other groups, and a positive correlation between β-ATP/Pi phosphorus ratio and A1C was found. In the analysis limited to the subgroup of normoalbuminuric patients, the difference in β-ATP/Pi was still detectable in KP patients compared with KD Transplantation. CONCLUSIONS —KP Transplantation was associated with better HEPs than in KD Transplantation, suggesting that restoration of β-cell function positively affects Kidney graft metabolism.

  • cardiovascular outcomes after Kidney Pancreas and Kidney alone Transplantation
    Kidney International, 2001
    Co-Authors: Ennio La Rocca, Paolo Fiorina, Valerio Di Carlo, M Cristallo, E Astorri, Claudio Rossetti, Giovanni Lucignani, Ferruccio Fazio, Daniela Giudici, Giuseppi Bianchi
    Abstract:

    Cardiovascular outcomes after Kidney–Pancreas and Kidney–alone Transplantation. Background This study retrospectively assessed, with an intention-to-treat analysis, the effect of Kidney–Pancreas Transplantation (KP) on survival and cardiovascular outcome in type 1 diabetic uremic patients. Methods A total of 351 uremic type 1 diabetic patients were enrolled on a waiting list for KP: 130 underwent KP Transplantation, 25 underwent Kidney Transplantation alone (KA), whereas 196 patients remained on dialysis (WL). The three populations had similar cardiovascular conditions. Actuarial survival rates and causes of death were recorded over a period of seven years. Finally, 23 KP and 13KA patients underwent left radionuclide ventriculography, during a follow-up of four years. Results In the entire group of 351 patients the seven-year survival rate was 77.4% for KP, 56.0% for KA and 39.6% for WL (KP vs. WL, P = 0.01). Cardiovascular death rate was 7.6% in KP, 20.0% in KA and 16.1% in WL (KP versus WL, P = 0.03; KP vs. KA, P = 0.16). In the subsample studied with radionuclide ventriculography, left ventricular ejection fraction improved in KP, but did not in KA, with significant differences between groups at two and four years. At four years only the KP patients presented normal values of diastolic parameters, including the peak filling rate, time-to-peak filling rate, and peak filling rate/peak ejection rate ratio. Glycated hemoglobin was negatively associated with the ejection fraction, peak filling rate and peak filling rate/peak ejection rate ratio, and positively associated with the time-to-peak filling rate. Conclusions Normalization of blood glucose metabolism and improvement of blood pressure control obtained with KP transplant is associated with positive effects on survival, cardiovascular death rate, and left ventricular function.

  • effects of Kidney Pancreas Transplantation on atherosclerotic risk factors and endothelial function in patients with uremia and type 1 diabetes
    Diabetes, 2001
    Co-Authors: Paolo Fiorina, Ennio La Rocca, Massimo Venturini, Fabio Minicucci, Isabella Fermo, Rita Paroni, Armando Dangelo, Marisa Sblendido, Valerio Di Carlo, M Cristallo
    Abstract:

    Cardiovascular disease and the development of coronary artery disease play a pivotal role in increasing mortality in patients with type 1 diabetes. The aim of our study was to evaluate the effects of Pancreas Transplantation on atherosclerotic risk factors, endothelial-dependent dilation (EDD), and progression of intima media thickness (IMT) in patients with uremia and type 1 diabetes after Kidney-alone (KA) or Kidney-Pancreas (KP) Transplantation. A cross-sectional study comparing two groups of patients with type 1 diabetes was performed. Sixty patients underwent KP Transplantation and 30 patients underwent KA Transplantation. Age and cardiovascular risk profile were comparable in patients before Transplantation. In all patients, atherosclerotic risks factors (lipid profile, fasting and post-methionine load plasma homocysteine, von Willebrand factor levels, D-dimer fragments, and fibrinogen) were assessed and Doppler echographic evaluation of IMT and endothelial function with flow-mediated and nitrate dilation of the brachial artery was performed. Twenty healthy subjects were chosen as controls (C) for EDD. Compared with patients undergoing KA Transplantation, patients undergoing KP Transplantation showed lower values for HbA1c (KP = 6.2 +/- 0.1% vs. KA = 8.4 +/- 0.5%; P < 0.01), fasting homocysteine (KP = 14.0 +/- 0.7 mcromol/l vs. KA = 19.0 +/- 2.0 micromol/l; P = 0.02), von Willebrand factor levels (KP = 157.9 +/- 8.6% vs. KA = 212.5 +/- 16.2%; P < 0.01), D-dimer fragments (KP = 0.29 +/- 0.02 microg/ml vs. KA = 0.73 +/- 0.11 microg/ml;P < 0.01), fibrinogen (KP = 363.0 +/- 11.1 mg/dl vs. KA = 397.6 +/- 19.4 mg/dl; NS), triglycerides (KP = 122.7 +/- 8.6 mg/dl vs. KA = 187.0 +/- 30.1 mg/dl; P = 0.01), and urinary albumin excretion rate (KP = 13.5 +/- 1.9 mg/24 h vs. KA = 57.3 +/- 26.3 mg/24 h; P < 0.01). Patients undergoing KP Transplantation showed a normal EDD (KP = 6.21 +/- 2.42%, KA = 0.65 +/- 2.74%, C = 8.1 +/- 2.1%; P < 0.01), whereas no differences were observed in nitrate-dependent dilation. Moreover, IMT was lower in patients undergoing KP Transplantation than in patients undergoing KA Transplantation (KP = 0.74 +/- 0.03 mm vs. KA = 0.86 +/- 0.09 mm; P = 0.04). Our study showed that patients with type 1 diabetes have a lower atherosclerotic risk profile after KP Transplantation than after KA Transplantation. These differences are tightly correlated with metabolic control, fasting homocysteine levels, lower D-dimer fragments, and lower von Willebrand factor levels. Normal endothelial function and reduction of IMT was observed only in patients undergoing KP Transplantation.

Livio Luzi - One of the best experts on this subject based on the ideXlab platform.

  • altered Kidney graft high energy phosphate metabolism in Kidney transplanted end stage renal disease type 1 diabetic patients a cross sectional analysis of the effect of Kidney alone and Kidney Pancreas Transplantation
    Diabetes Care, 2007
    Co-Authors: Paolo Fiorina, Antonio Secchi, Livio Luzi, Chiara Gremizzi, Gianluca Perseghin, Francesco De Cobelli, Alessandra Petrelli, L D Monti, Paola Maffi, Alessandro Del Maschio
    Abstract:

    OBJECTIVE —Diabetes, hypertension, dyslipidemia, obesity, nephrotoxicity of certain immunosuppressive drugs, and the persistence of a chronic alloimmune response may significantly affect graft survival in end-stage renal disease (ESRD) type 1 diabetic patients who have undergone Kidney transplant. The aim of this study was to ascertain the impact of Kidney alone (KD) or combined Kidney-Pancreas (KP) Transplantation on renal energy metabolism. RESEARCH DESIGN AND METHODS —We assessed high-energy phosphates (HEPs) metabolism by using, in a cross-sectional fashion, 31 P-magnetic resonance spectroscopy in the graft of ESRD type 1 diabetic transplanted patients who received KD ( n = 20) or KP ( n = 20) transplant long before the appearance of overt chronic allograft nephropathy (CAN). Ten nondiabetic microalbuminuric Kidney transplanted patients and 10 nondiabetic Kidney transplanted patients with overt CAN were chosen as controls subjects. RESULTS —Simultaneous KP Transplantation patients showed a higher β-ATP/inorganic phosphorus (Pi) ratio (marker of the graft energy status) versus the other groups, and a positive correlation between β-ATP/Pi phosphorus ratio and A1C was found. In the analysis limited to the subgroup of normoalbuminuric patients, the difference in β-ATP/Pi was still detectable in KP patients compared with KD Transplantation. CONCLUSIONS —KP Transplantation was associated with better HEPs than in KD Transplantation, suggesting that restoration of β-cell function positively affects Kidney graft metabolism.

  • persistence of anomalies in the growth hormone releasing hormone stimulated growth hormone response in diabetic uremic patients after combined Kidney Pancreas Transplantation
    Transplantation, 2000
    Co-Authors: M E Malighetti, V Di Carlo, G Pozza, C Berra, Antonio Secchi, Livio Luzi
    Abstract:

    Increased circulating growth hormone (GH) levels and aberrant response to different stimuli characterize both type 1 diabetes mellitus and chronic uremia and are associated with severe retinal, Kidney and heart complications. Combined Kidney and Pancreas Transplantation is a therapy that restores the endogenous, closed-loop, insulin secretion in diabetes and cure uremia. To evaluate if combined Transplantation can restore a normal secretion and response of GH to growth hormone releasing hormone (GH-RH), we studied four groups of subjects: (1) seven type 1 diabetic patients with end-stage renal failure who had received Pancreas and Kidney Transplantation (KPTx); (2) six diabetic uremic subjects, candidates for combined Transplantation (IDDUP); (3) nine patients with chronic uveitis on immunosuppressive therapy comparable to Pancreas recipients, six of whom treated only with prednisone (UVEST), while three (4) were treated with both prednisone and cyclosporin (UVESTCY). All subjects underwent a GH-RH test (50 microg intravenously, i.v., at 13:00 h). Serum insulin levels were significantly higher in IDDUP compared to UVEST (P=0.05) both at baseline and post GH-RH stimulus, while were similar to KPTx (P=0.2) and UVESTCY (P=0.7). In contrast, plasma free fatty acids were similar in all groups. In IDDUP baseline plasma glycerol was higher than in KPTx (P=0.04) and UVEST (P=0.02) and similar to UVESTCY (P=0.36); glycerol concentration did not change after GH-RH (P=0.08). Before and after GH-RH, serum GH levels tended to be higher in IDDUP (P=0.5) and KPTx (P=0.2) compared to UVEST and UVESTCY. Our results indicate that: 1) Kidney-Pancreas Transplantation does not normalize the GH response to GH-RH; 2) GH abnormalities are not due either to the chronic immunosuppressive therapy or to the insulin effect on GH release; 3) GH abnormalities are probably secondary to functional and/or organic complications of the hypothalamus and/or pituitary as a sequela of diabetes mellitus.

Sudhakar K Reddy - One of the best experts on this subject based on the ideXlab platform.

  • impact of acute rejection episodes on long term graft survival following simultaneous Kidney Pancreas Transplantation
    American Journal of Transplantation, 2003
    Co-Authors: Sudhakar K Reddy, Thomas D Johnston, Thomas Waid, Bruce A Lucas, Darcy Davies, Debra Ormond, Sony Tuteja, J W Mckeown, Dinesh Ranjan
    Abstract:

    Although it is well established that acute rejection is one of the major risk factors for chronic graft loss following Kidney Transplantation, its effect on long-term graft survival following simultaneous Kidney-Pancreas transplants (SKPTs) is less well known. We analyzed a large cohort of SKPTs and cadaver Kidney transplants reported to the United Network for Organ Sharing database during 1988–97, to determine the impact of acute rejection episodes on long-term Kidney and Pancreas graft survival. Only patients whose Kidney and Pancreas grafts had survived for at least 1 year were included. Other potential risk factors influencing long-term graft survival were included in the analysis. Of the 4251 SKPTs, 45% had no acute rejection, 36% had Kidney only rejection, 3% had Pancreas only rejection, and 16% had both Kidney and Pancreas rejection within the 1st year post transplant. The 5-year Kidney and Pancreas graft survival rates adjusted for other risk factors were 91% and 85%, respectively; for those with no acute rejection episodes, 88% and 84%, respectively; for those with Kidney only rejection, 94% and 83%, respectively; for those with Pancreas only rejection; and 86% and 78%, respectively, for those with both Kidney and Pancreas rejection. The relative risk (RR) of Kidney graft failure was 1.32 when acute rejection involved the Kidney graft only, while the RR was 1.53 when the rejection involved both organs. We conclude that acute rejection episodes have a negative impact on the long-term Kidney graft survival in the SKPT population similar to that in the cadaver Kidney transplant population. Patients who had acute rejection episodes of both Kidney and Pancreas have the worst long-term graft survival.

  • long term survival following simultaneous Kidney Pancreas Transplantation versus Kidney Transplantation alone in patients with type 1 diabetes mellitus and renal failure
    American Journal of Kidney Diseases, 2003
    Co-Authors: Sudhakar K Reddy, Don Stablein, S Taranto, Robert J Stratta, Thomas D Johnston, Thomas Waid, Wade J Mckeown, Bruce A Lucas, Dinesh Ranjan
    Abstract:

    Abstract Background: Pancreas Transplantation improves quality of life and prevents the progression of secondary complications of diabetes. Whether these benefits translate into a long-term survival advantage is not entirely clear. Methods: Using the United Network for Organ Sharing database, we analyzed long-term survival in 18,549 patients with type 1 diabetes and renal failure who received a Kidney transplant between 1987 and 1996. Patient survival was calculated using the Kaplan-Meier method. Proportional hazards models were used to adjust for effects of differences in recipient and donor variables between simultaneous Kidney-Pancreas transplants (SKPTs) and Kidney-alone transplants. Results: SKPT and living donor Kidney recipients had a significant crude survival distribution advantage over cadaver Kidney transplant recipients (8-year survival rates: 72% for SKPT recipients, 72% for living donor Kidney recipients, and 55% for cadaver Kidney recipients). The survival advantage for SKPT recipients over cadaver Kidney recipients diminished, but persisted after adjusting for donor and recipient variables and Kidney graft function as time-varying covariates. SKPT recipients had a high mortality risk relative to living donor Kidney recipients through 18 months postTransplantation (hazards ratio, 2.2; P

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