Pancreas transplant alone delivers poor survival in uraemic patients with diabetes

Although a viable treatment option in patients with diabetes complicated by end-stage renal disease, pancreas transplant alone in uraemic (PTAU) patients confers inferior survival, graft survival, and immunological outcomes relative to simultaneous pancreas-kidney (SPK) transplant, a recent study has found.

Researchers enrolled 160 patients undergoing pancreas transplant, including 26 (16 percent) PTAU and 37 (23 percent) SPK patients. Baseline characteristics, such as sex, body mass index, diabetes onset and duration, were comparable across the different pancreas transplant procedure subgroups.

The primary outcome of 5-year patient survival was 66.2 percent in the PTAU arm, markedly lower than the 94.5-percent survival rate in the SPK group. Five-year survival rates were likewise higher in patients who received pancreas-after-kidney transplant (PAK; 95.8 percent). Such differences in survival rates were apparent even at 1 year and persisted until 10 years.

Graft survival was likewise worse in the PTAU subgroup when considering graft loss due to patient death as the event of interest (p=0.002). The 5-year death-uncensored pancreas graft survival was only 67.0 percent in PTAU, as opposed to 100 percent in PAK, 91.3 percent in SPK, and 74.0 percent in PTA.

PTAU likewise led to worse surgical and immunological outcomes such as a higher pancreas graft loss rate due mainly to patient death. Of note, complication rates were lower in PTAU relative to other subgroups, and there were no reported cases of PTAU chronic rejection.

“Subsequent kidney transplant following successful pancreas transplant should be encouraged whenever possible because PTAU patients might be more vulnerable to cardiac events, cerebrovascular accident, infection, and malignancy,” the researchers said.

“Nevertheless, modification of the organ allocation policies to prioritize SPK transplant in eligible patients should be the prime goal and PTAU should be avoided,” they added.