medwireNews: Choosing simultaneous pancreas–kidney (SPK) transplantation as the preferred treatment strategy for patients with type 1 diabetes and end-stage renal disease could nearly halve the risk for death 10 years later compared with kidney transplantation alone, research suggests.
The study of nearly 3000 Dutch adults revealed that those treated in the Leiden region, where a strategy favoring SPK results in it being used in eight out of 10 cases, had a 44% decreased likelihood of all-cause death at 10 years compared with patients from other regions where kidney transplantation alone is the primary strategy and SPK transplantation is used in only three in every 10 cases.
By 20 years, the disparity in all-cause death had narrowed slightly but there remained a 31% decreased likelihood of death among the patients treated at the Leiden transplant center compared with the seven other Dutch transplant centers, where the primary intention was to treat with kidney transplantation alone.
When deceased and living donor kidney transplantation were analyzed separately, the SPK survival advantage was only significant with the former.
Nonetheless, the researchers maintain: “These results encourage care providers and guidelines to adopt SPK transplantation as the preferred treatment option for patients with type 1 diabetes with or approaching end-stage renal disease.”
The findings come from 2796 patients with type 1 diabetes who started renal replacement therapy between 1986 and 2016, 996 of whom received a first kidney transplant from either a dead (42%) or living (16%) donor or SPK dual transplantation (42%).
Those receiving solely a dead or living donor kidney were older than those undergoing SPK transplantation, with a mean age at transplantation of 50 and 48 versus 42 years, respectively.
Kevin Esmeijer (Leiden University Medical Center, the Netherlands) and colleagues report that the corresponding median survival in the three groups was 7.3, 10.5, and 16.5 years.
In comparison with individuals who received a kidney from a dead donor, those who received SPK transplantation had a 33% decreased likelihood of dying at 10 years and a 21% decreased likelihood of dying at 20 years, after adjusting for potential confounding factors, including dialysis vintage and modality.
Survival duration was longest among the 91% of individuals receiving SPK transplants who had functioning pancreas grafts at 1 year, at a median of 17.4 years versus 10.7 years for those whose pancreas graft had failed by this point. The risk for death for those whose graft failed after a year also increased to that equivalent of individuals who solely received a kidney transplant from a dead donor.
Reporting in Diabetes Care, the authors summarize: “This is the first study that clearly shows that patients with type 1 diabetes, both 10 and 20 years after SPK transplant, had a substantially higher life expectancy as compared with those who received a living- or deceased-donor kidney transplant alone.”
By Anita Chakraverty
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