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Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant

BACKGROUND: Donor and other differences mean understanding drivers of transplant survival for type 1 diabetics is challenging. We aimed to compare outcomes of simultaneous pancreas‐kidney transplant over kidney transplant alone for people with end‐stage kidney disease (ESKD) and type 1 diabetes. MET...

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Autores principales: Hedley, James A., Kelly, Patrick J., Webster, Angela C.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley & Sons Australia, Ltd 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543845/
https://www.ncbi.nlm.nih.gov/pubmed/35352447
http://dx.doi.org/10.1111/ans.17663
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author Hedley, James A.
Kelly, Patrick J.
Webster, Angela C.
author_facet Hedley, James A.
Kelly, Patrick J.
Webster, Angela C.
author_sort Hedley, James A.
collection PubMed
description BACKGROUND: Donor and other differences mean understanding drivers of transplant survival for type 1 diabetics is challenging. We aimed to compare outcomes of simultaneous pancreas‐kidney transplant over kidney transplant alone for people with end‐stage kidney disease (ESKD) and type 1 diabetes. METHODS: We performed a population‐based cohort study comparing outcomes from kidney alone and kidney‐pancreas transplants using registry data. Our study population was people in Australia and New Zealand with type 1 diabetes and ESKD who received a kidney transplant in 1984–2016. Primary outcomes were time to kidney transplant failure and all‐cause death. Secondary outcomes were time to cardiovascular and non‐cardiovascular death. We compared adjusted survival using Cox regression (hazard ratio HR and 95% confidence intervals CI). RESULTS: Of 1295 type 1 diabetics receiving a transplant, 430 (33%) received deceased donor kidney, 172 (13%) received living donor kidney, and 693 (54%) received pancreas‐kidney transplant. Compared to deceased donor kidney, pancreas‐kidney recipients had 40% lower rate of kidney transplant failure (adjusted HR 0.60; 95% CI 0.45–0.81; p = 0.001) and 34% lower mortality (adjusted HR 0.66; 95% CI 0.53–0.83; p < 0.001), driven by 49% reduction in cardiovascular mortality (adjusted HR 0.51; 95% CI 0.36–0.72; p < 0.001). Pancreas‐kidney recipients had similar reductions in transplant failure and mortality compared to living kidney recipients, after adjusting for transplant timing. CONCLUSIONS: For people with type 1 diabetes, pancreas‐kidney transplant provides improved transplant and overall survival compared to deceased donor kidney alone. Living donor kidneys may perform just as well as pancreas‐kidney transplant if waiting times are short.
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spelling pubmed-95438452022-10-14 Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant Hedley, James A. Kelly, Patrick J. Webster, Angela C. ANZ J Surg Transplantation Surgery BACKGROUND: Donor and other differences mean understanding drivers of transplant survival for type 1 diabetics is challenging. We aimed to compare outcomes of simultaneous pancreas‐kidney transplant over kidney transplant alone for people with end‐stage kidney disease (ESKD) and type 1 diabetes. METHODS: We performed a population‐based cohort study comparing outcomes from kidney alone and kidney‐pancreas transplants using registry data. Our study population was people in Australia and New Zealand with type 1 diabetes and ESKD who received a kidney transplant in 1984–2016. Primary outcomes were time to kidney transplant failure and all‐cause death. Secondary outcomes were time to cardiovascular and non‐cardiovascular death. We compared adjusted survival using Cox regression (hazard ratio HR and 95% confidence intervals CI). RESULTS: Of 1295 type 1 diabetics receiving a transplant, 430 (33%) received deceased donor kidney, 172 (13%) received living donor kidney, and 693 (54%) received pancreas‐kidney transplant. Compared to deceased donor kidney, pancreas‐kidney recipients had 40% lower rate of kidney transplant failure (adjusted HR 0.60; 95% CI 0.45–0.81; p = 0.001) and 34% lower mortality (adjusted HR 0.66; 95% CI 0.53–0.83; p < 0.001), driven by 49% reduction in cardiovascular mortality (adjusted HR 0.51; 95% CI 0.36–0.72; p < 0.001). Pancreas‐kidney recipients had similar reductions in transplant failure and mortality compared to living kidney recipients, after adjusting for transplant timing. CONCLUSIONS: For people with type 1 diabetes, pancreas‐kidney transplant provides improved transplant and overall survival compared to deceased donor kidney alone. Living donor kidneys may perform just as well as pancreas‐kidney transplant if waiting times are short. John Wiley & Sons Australia, Ltd 2022-03-30 2022 /pmc/articles/PMC9543845/ /pubmed/35352447 http://dx.doi.org/10.1111/ans.17663 Text en © 2022 The Authors. ANZ Journal of Surgery published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Surgeons. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
spellingShingle Transplantation Surgery
Hedley, James A.
Kelly, Patrick J.
Webster, Angela C.
Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant
title Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant
title_full Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant
title_fullStr Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant
title_full_unstemmed Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant
title_short Patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant
title_sort patient and kidney transplant survival in type 1 diabetics after kidney transplant alone compared to simultaneous pancreas‐kidney transplant
topic Transplantation Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9543845/
https://www.ncbi.nlm.nih.gov/pubmed/35352447
http://dx.doi.org/10.1111/ans.17663
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