 |
|
Survival After Pancreas Transplantation in Patients With Diabetes and Preserved Kidney Function
Jeffrey M. Venstrom, BS;
Maureen A. McBride, PhD;
Kristina I. Rother, MD;
Boaz Hirshberg, MD;
Trevor J. Orchard, MD, MMedSci;
David M. Harlan, MD
JAMA. 2003;290:2817-2823.
Context Solitary pancreas transplantation (ie, pancreas alone or pancreas-after-kidney) for diabetes mellitus remains controversial due to procedure-associated morbidity/mortality, toxicity of immunosuppression, expense, and unproven effects on the secondary complications of diabetes. Whether transplantation offers a survival advantage over conventional therapies for diabetes is unknown.
Objective To determine the association between solitary pancreas transplantation and survival in patients with diabetes and preserved kidney function.
Design, Setting, and Patients Retrospective observational cohort study conducted at 124 transplant centers in the United States, in 11 572 patients with diabetes mellitus on the waiting list for pancreas transplantation (pancreas alone, pancreas-after-kidney, or simultaneous pancreas-kidney) at the United Network for Organ Sharing/Organ Procurement and Transplantation Network between January 1, 1995, and December 31, 2000. All patients receiving a multiorgan (other than simultaneous pancreas-kidney) transplant were excluded, as were those listed for solitary pancreas transplantation who had a serum creatinine level greater than 2 mg/dL (176.8 µmol/L) at time of listing, or who ultimately received a simultaneous pancreas-kidney transplant.
Main Outcome Measure All-cause mortality within 4 years following transplantation (or within a comparable time on the waiting list for the group not undergoing transplantation).
Results Overall relative risk of all-cause mortality for transplant recipients (compared with patients awaiting the same procedure) over 4 years of follow-up was 1.57 (95% confidence interval [CI], 0.98-2.53; P = .06) for pancreas transplant alone, 1.42 (95% CI, 1.03-1.94; P = .03) for pancreas-after-kidney transplant, and 0.43 (95% CI, 0.39-0.48) for simultaneous pancreas-kidney transplant. Transplant patient 1- and 4-year survival rates were 96.5% and 85.2% for pancreas transplant alone, respectively, and 95.3% and 84.5% for pancreas-after-kidney transplant, while 1- and 4-year survival rates for patients on the waiting list were 97.6% and 92.1% for pancreas transplant alone, respectively, and 97.1% and 88.1% for pancreas-after-kidney transplant.
Conclusion From 1995-2000, survival for those with diabetes and preserved kidney function and receiving a solitary pancreas transplant was significantly worse compared with the survival of waiting-list patients receiving conventional therapy.
Author Affiliations: Transplantation and Autoimmunity Branch, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services, Bethesda, Md (Mr Venstrom and Drs Rother, Hirshberg, and Harlan); Vanderbilt University School of Medicine, Nashville, Tenn (Mr Venstrom); United Network for Organ Sharing, Richmond, Va (Dr McBride); Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa (Dr Orchard); and Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Harlan).
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
First-Trimester Human Fetal Pancreas Transplantation for Type 1 Diabetes Treatment: An Alternative Approach for Achieving Long-Term Graft Survival?
Fousteri and von Herrath
Diabetes 2008;57:525-526.
FULL TEXT
Imaging Islets Labeled With Magnetic Nanoparticles at 1.5 Tesla
Tai et al.
Diabetes 2006;55:2931-2938.
ABSTRACT
| FULL TEXT
Preemptive Transplantation for Patients With Diabetes-Related Kidney Disease
Becker et al.
Arch Intern Med 2006;166:44-48.
ABSTRACT
| FULL TEXT
Survival After Pancreas Transplantation
Gruessner et al.
JAMA 2005;293:675-675.
FULL TEXT
Update in Endocrinology
Schlechte
ANN INTERN MED 2005;142:126-131.
FULL TEXT
Transplantation and Islet Topics
Bloomgarden
Diabetes Care 2005;28:213-219.
FULL TEXT
Pancreas Transplantation: Indications and Consequences
Larsen
Endocr. Rev. 2004;25:919-946.
ABSTRACT
| FULL TEXT
Autoimmune Polyendocrine Syndromes
Eisenbarth and Gottlieb
NEJM 2004;350:2068-2079.
FULL TEXT
Islet Transplantation as a Treatment for Diabetes
Harlan et al.
NEJM 2004;350:2104-2104.
FULL TEXT
Benefits and Risks of Solitary Islet Transplantation for Type 1 Diabetes Using Steroid-Sparing Immunosuppression: Response to Charles and Selam
Hirshberg et al.
Diabetes Care 2004;27:1250-1251.
FULL TEXT
Gene-Altered Islets for Transplant: Giant Leap or Small Step?
Harlan
Endocrinology 2004;145:463-466.
FULL TEXT
Isolated Pancreas Transplantation for Type 1 Diabetes: A Doctor's Dilemma
Nathan
JAMA 2003;290:2861-2863.
FULL TEXT
|
