Pancreas Retransplant after Pancreas Graft Failure in Simultaneous Pancreas-kidney Transplants Is Associated with Better Kidney Graft Survival

Sandesh Parajuli, Annamalai Arunachalam, Kurtis J. Swanson, Fahad Aziz, Neetika Garg, Natalie Bath, Robert R. Redfield, Dixon Kaufman, Arjang Djamali, Jon Odorico, Didier A. Mandelbrot

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Background. Simultaneous pancreas-kidney (SPK) transplant is usually the best option for the diabetic end-stage renal disease patient. There is limited information about kidney graft outcomes in SPK recipients with isolated pancreas graft failure who do versus do not undergo pancreas retransplantation. Methods. Patients were divided into 2 groups based on whether they underwent pancreas retransplant (ReTx+) or not (ReTx-). Kidney graft function and survival were the primary endpoints. Results. One hundred and nine patients satisfied our selection criteria, 25 in ReTx+ and 84 in ReTx-. Mean interval from SPK to pancreas failure was significantly shorter in the ReTx+ compared with the ReTx- group, 19.3 ± 36.7 versus 45.7 ± 47.0 months (P = 0.01), respectively. There was no significant difference in kidney graft follow-up post SPK between 2 groups (P = 0.48). At last follow-up, 15 of the 25 (60%) of the repeat pancreas graft had failed, with a mean graft survival among these failed pancreas graft of 2.6 ± 2.7 years, ranging from 0 to 8.1 years. Uncensored kidney graft failure was significantly lower in the ReTx+ group compared with the ReTx- group, 44% versus 67% (P = 0.04). Death-censored kidney graft failure was also lower in the ReTx+ group, 24% versus 48% (P = 0.04). The difference in patient survival did not reach statistical significance. In adjusted Cox regression analysis, rejection as a cause of pancreas failure was associated with increased risk of death-censored kidney graft failure, and pancreas retransplantation was associated with decreased risk of kidney graft failure. A similar pattern was seen after 1:1 matching for the interval between SPK and pancreas graft failure. Conclusions. Even though ReTx+ patients accept the risks associated with repeat pancreas surgery, providers should consider this option in suitable otherwise healthy patients.

Original languageEnglish (US)
Article numbere473
JournalTransplantation Direct
Volume5
Issue number8
DOIs
StatePublished - Aug 1 2019
Externally publishedYes

Bibliographical note

Funding Information:
Received 29 May 2019. Revision received 6 June 2019. Accepted 8 June 2019. 1Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI. 2Division of Transplant Surgery, University of Wisconsin School of Medicine and Public Health, Madison, WI. The authors declare no conflicts of interest. This work was supported by an unrestricted research grant from the Virginia Lee Cook Foundation. The clinical and research activities being reported are consistent with the Principles of the Declaration of Istanbul as outlined in the Declaration of Istanbul on Organ Trafficking and Transplant Tourism. S.P. participated in study concept, design, data collection, analysis, manuscript preparation, and editing. A.A., K.S., and N.G. performed data collection, manuscript preparation, and editing. F.A., N.G., R.R., D.K., and A.D. participated

Publisher Copyright:
© 2019 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.

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