Incremental Value of the Pancreas Allograft to the Survival of Simultaneous Pancreas-Kidney Transplant Recipients
- Paolo R. Salvalaggio, MD, PHD1,2,
- Nino Dzebisashvili, MS1,
- Brett Pinsky, MS1,
- Mark A. Schnitzler, PHD1,
- Thomas E. Burroughs, PHD1,
- Ralph Graff, MD1,2,
- David A. Axelrod, MD1,3,
- Daniel C. Brennan, MD1 and
- Krista L. Lentine, MD, MS1,4
- 1Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, Missouri;
- 2Department of Surgery, University of Washington, Seattle, Washington;
- 3Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire;
- 4Division of Nephrology, Saint Louis University School of Medicine, St. Louis, Missouri.
- Corresponding author: Paolo R. Salvalaggio, psalvala{at}u.washington.edu.
Abstract
OBJECTIVE To quantify the incremental survival benefit of the pancreas allograft in simultaneous pancreas-kidney (SPK) transplant recipients.
RESEARCH DESIGN AND METHODS Data from the national transplant database from 2000 to 2007 were analyzed. SPK recipients who had functioning allografts to 1-year post transplant (n = 3,304) were compared with those who had failure of the renal (n = 233) or pancreatic (n = 112) graft. The main outcome was a projection of 10 life-years of patient survival beyond the first transplant anniversary.
RESULTS Recipients with function of both organs accrued 9.4 life-years following transplantation. Projected survival in patients with kidney failure was reduced to 2.5 life-years. Pancreas failure reduced predicted survival to 8 life-years. Renal allograft failure impacts life expectancy significantly (adjusted hazard ratio [aHR] 12.13). However, pancreas allograft failure was also associated with reduced survival (aHR 2.62).
CONCLUSIONS Although the majority of the survival benefit of SPK transplant is due to the renal transplant, pancreas allograft function does contribute to patient survival.
Footnotes
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The interpretation and reporting of these data are the sole responsibility of the authors and should in no way be seen as representing the official policy of or interpretation by the Organ Procurement and Transplantation Network, the American Society of Transplantation, or the U.S. government.
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The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.
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- Received September 18, 2008.
- Accepted January 6, 2009.
- © 2009 by the American Diabetes Association.
