Double transplant seen best for diabetics

People with diabetes are prone to develop kidney damage that warrants a transplant, but they do best ultimately when they are given a simultaneous pancreas-kidney transplant rather than a kidney graft alone, new research shows.

The advantage of a pancreas-kidney transplant is that it offers the chance of curing not only the kidney disease but also the underlying diabetes.

Dr. Alexander C. Wiseman, from the University of Colorado Health Sciences Center, Aurora, and colleagues report that survival rates in the first year are actually slightly lower with simultaneous pancreas-kidney transplantation than with kidney-only transplantation from a living donor, at 95.9 percent vs 97.2 percent.

Thereafter, however, survival rates are better with simultaneous pancreas-kidney transplantation.

Specifically, after 7 years, survival rates of patients given a simultaneous pancreas-kidney transplant was 88.6 percent, significantly higher than the 80.0 percent with a living-donor kidney transplant, 73.9 percent with a simultaneous pancreas-kidney transplant when the pancreas graft fails, and 64.8 percent with a deceased-donor kidney transplant.

The study, reported in the Clinical Journal of the American Society of Nephrology, looked at nearly 10,000 patients who underwent the various types of transplantation from 1997 to 2005.

Patients with type 1 diabetes and kidney failure have a difficult decision to make, Wiseman comments in a press release. "Should they try to get on the waiting list for simultaneous pancreas-kidney transplant and assume the greater surgical risk, or should they accept a kidney from a living donor and live with continued diabetes?"

He and his colleagues conclude, "These data help further clarify the decision-making of simultaneous pancreas-kidney versus kidney-alone transplant options of patients and providers."

SOURCE: Clinical Journal of the American Society of Nephrology, May 2009.