Douzdjian V, Rice JC, Gugliuzza KK, Fish JC, Carson RW
Renal allograft and patient outcome after transplantation:
pancreas-kidney versus kidney-alone transplants in type
I diabetics vs kidney-alone transplants in nondiabetics
Am J Kidney Dis
(Jan) 27:106-116 1996
With advances in immunosuppression and technique, outcome of simultaneous
pancreas-kidney (SPK) transplantation has improved over the last decade.
However, there is still contoversy about this procedure, with relatively
poor results reported from some conters (see
Manske et al. . In
this study from the University of Texas at Galveston, the fate of SPK (n=61)
done between 1988-1994
was compared to kidney alone-transplants in diabetic (KA-D) (n=63) and
kidney alone-transplants in nondiabetic (KA-ND)(n=80) patients matched for
donor age, gender, race,
interval from donor admission to procurement, DR mismatch, and recipient
gender. Patient survival was highest in the KA-ND group (86% at 5 yr),
intermediate (78%) in the SPK group, and lowest (66%) in the KA-D group
(allograft survival was also lower in the KA-D group). Acute rejection was
most frequent in SPK patients, although this did not affect graft survival.
The authors conclude that outcome after SPK is acceptable, although they
admit that selection bias may have favored the SPK group. (David J.
Loyola University, Maywood, IL)