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Presenter: AC, Gruessner, Syracuse, United States
Authors: Rainer WG Gruessner, Mark R Laftavi, Oleh Pankowycz, Vaughn Whittaker, Zeki Acun, Vikram Aggarval, Nuri Ozden, Angelika C Gruessner
R. Gruessner1, M. Laftavi1, O. Pankowycz1, V. Whittaker1, Z. Acun1, V. Aggarval1, N. Ozden1, A. Gruessner1.
1SUNY Upstate Medical University, Syracuse, New York, US,
Background and Study Purpose: Pancreas and/or kidney transplantation has provided tremendous progress for diabetic patients.
The purpose of this study was to determine the survival benefit of pancreas and/or kidney transplants as reported over a 28-year time period (10/1987 - 12/2015) according to the United Network for Organ Sharing (UNOS) database and the Social Security Administration Death Master File for type 1 diabetic patients.
Methods: In this retrospective UNOS data analysis, we reviewed the records of 60,826 adult type 1 diabetic patients listed for primary pancreas and/or kidney transplant (Kidney Transplant Alone [KTA], Pancreas after Kidney Transplant [PAK] , Pancreas Transplant Alone [PTA], Simultaneous Pancreas and Kidney Transplant [SPK]). Of these, 43,143 patients underwent a transplant and 17,679 patients were placed on the waiting list and did not undergo a transplant or are still on the waiting list.
We adjusted our analyses for multiple listings, incomplete diabetes classification and missing data. Primary outcome was patient survival while on the waiting list or after transplant. Patient survival was computed according to Kaplan-Meier for time-to-event analysis.
Results: Waiting list mortality rates at 1- and 5-years for type 1 KTA recipients were 6% and 43%; for SPK recipients, 6% and 50%; for Solitary Pancreas Transplants (PTA, PAK) recipients, 3% and 16% (p < 0.05).
Type 1 diabetic patient survival at 10-years after transplantation was as follows: for Deceased Donor [DD] KTA, 39%; Living Donor [LD] KTA, 62%; SPK, 68%; PTA, 67%; PaDDKd, 54%; PaLDKd, 65%.
We found that a total of 316,237 life-years were saved to date during the 28 years of pancreas and/or kidney transplants in type 1 diabetics. Saved life-years for DD KTA recipients was 132,254; for SPK recipients, 152,895 yrs; for PAK & PTA recipients, 31,087 yrs. This resulted in 5.12 yrs life–years that were saved for every type 1 diabetic recipient of a pancreas and/or kidney transplant. The average observed number of life-years saved for DD KTA recipients was 4.32 yrs; for SPK recipients, 6.51 yrs; for PAK & PTA recipients, 4.76 yrs. The difference was highly significant (p < 0.0001).
Conclusions: Our analysis demonstrates the following: (1) Waiting list mortality was highest for SPK and DD KTA; (2) Patient survival was highest after SPK, PTA and PaLDKd; the lowest patient survival rate was noted in DD KTA; (3) At 10-years, patient mortality rates after transplantation vs. wait list mortality for SPK recipients were 32% vs 82% and for DD KTA recipients 61% and 84%; (4) More average life-years were saved with SPK and PTA/PAK than with DD KTA; (5) To date, primary pancreas and kidney transplants in type 1 diabetics have saved a total of 316,237 life-years.
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