Low Rates of Short- and Long-term Graft Loss After Kidney-Pancreas Transplant From a Single Center Low Graft Loss Rates in Kidney-Pancreas Transplant

Tai DS, Hong J, Busuttil RW, et al. — Mon, 01 Apr 2013 00:00:00 GMT

Importance

Since the 1980s, pancreas transplant has become the most effective treatment strategy to restore euglycemia in patients with type 1 diabetes mellitus. However, technical complications and BK virus nephropathy continue to be important causes of early and late graft loss. These and other complications lead to cited 1- and 3-year graft survival rates of 74% and 67% (pancreas) and 81% and 73% (kidney).

Objective

To examine our center's outcomes with pancreas-kidney transplant and early BK virus screening and treatment.

Design

Prospective study from August 2004 to January 2012.

Setting

University medical center.

Participants

Sixty-five patients with type 1 diabetes who underwent simultaneous kidney and pancreas, pancreas after kidney, or pancreas transplant alone at a single center.

Intervention

Pancreas transplant.

Main Outcome Measures

Pancreas and kidney survival; patient survival; and kidney loss due to BK virus nephropathy.

Results

Patient survival at 1, 3, and 5 years was 100%, 98.4%, and 98.4%, respectively. Of 2 early pancreatic allograft losses, 1 was due to thrombosis (1.6%). One- and 5-year pancreas graft survival rates were 95.4% and 92.3%; losses after more than 1 year were due to rejection. Kidney survival rates were 100% and 95.2% at 1 and 5 years; losses were due to nephropathy and noncompliance, with 1 death with function. BK virus incidence was 29.2%, with no graft losses due to BK infection.

Conclusions and Relevance

While pancreas transplant can be complicated by early graft loss, our results suggest that excellent outcomes at 5 years can be achieved. Posttransplant BK virus screening and treatment are essential tools to long-term success.

JAMA Surgery: Transplantation Topic Collection

Low Rates of Short- and Long-term Graft Loss After Kidney-Pancreas Transplant From a Single Center Low Graft Loss Rates in Kidney-Pancreas Transplant