Keywords
Alemtuzumab induction; Cold ischemia time; Donor age; Era; Simultaneous pancreas-kidney transplant
Abstract
Introduction: The study purpose was to analyze in consecutive periods our nearly 19-year experience in simultaneous pancreas-kidney transplantation (SPKT) with an emphasis on changes in practice that improved outcomes in the most recent era.
Methods: Single center retrospective cohort study of all SPKTs performed in two sequential eras: Era 1 (E1): 11/1/2001 – 12/31/2010; Era 2 (E2) 1/1/2011 - 8/12/20). Immunosuppression and management protocols were standardized in both eras.
Results: 255 consecutive SPKTs were analyzed (E1, n=126; E2, n=129). By design, E2 patients received organs from younger donors (mean E1 28.1 vs. E2 23.7 years) with shorter pancreas cold ischemia times (CITs, mean E1 16.8 vs. E2 13.4 hours, both p<0.05). In addition, donors with either hypertension or cerebrovascular cause of death were more common in E1 compared to E2 (both p<0.05). More E2 patients received alemtuzumab induction (52.4% E1 vs 97.7% E2, p<0.0001). One-year pancreas graft survival rates (PGSRs, 84.9% Era 1 versus 94.6% Era 2, p=0.02) and four-year PGSRs (70.6% E1 versus 85.5% E2, p=0.002) were significantly higher in E2 and by Kaplan-Meier analysis. In univariate analysis, alemtuzumab induction and E2 were associated with superior and longer pancreas CIT with inferior death-censored PGSRs. Only alemtuzumab induction had a significant (protective) effect on censored PGSR in the multivariate model.
Conclusions: In our experience, optimizing donor quality (younger donors without hypertension or cerebrovascular cause of death), minimizing pancreas CIT, and use of alemtuzumab induction are associated with improved outcomes following SPKT.
Abbreviations
BMI: Body Mass Index; CIT: Cold Ischemia Time; CMV: Cytomegalovirus; DWFG: Death with a Functioning Graft; GSR: Graft Survival Rate; HR: Hazard Ratio; P-E: Portal-Enteric; PTx: Pancreas Transplant; RATG: Rabbit Anti-Thymocyte Globulin; S-E: Systemic-Enteric; SPKT: Simultaneous Pancreas-Kidney Transplant; US: United States