O311* Aims: Pancreas transplantation after living kidney transplantation (PAK) is a commonly followed treatment strategy in patients with end stage renal disease secondary to type-1 diabetes. The aim of this strategy is to minimize waiting time to kidney transplantation in, while still benefiting from a pancreas transplant subsequently. Long-term benefits of adequate blood sugar control are thought, but have not been proven to, outweigh the potential risks of the subsequent pancreas transplant. To answer this question, we examined 6,987 adults with end stage renal disease (ESRD) secondary to type-I diabetes who received a living renal transplant from 1995-2003 recorded in the Scientific Registry of Transplant Recipients (SRTR). Within this cohort, 553 received an additional pancreas transplant following their kidney transplant. Methods: We analyzed the impact of the PAK procedure relative to the remaining cohort who did not receive the additional transplant, by constructing a time-dependent proportional hazard model, adjusted for known risk factors along with a time-dependent variable of time to pancreas transplant. We measured outcomes of overall kidney graft survival, death censored kidney graft survival, and patient survival. In addition, we examined the impact of the PAK procedure on short and long-term renal function. Results: Our model demonstrated a detrimental impact of the PAK procedure on overall renal graft survival (RR=1.459, CI 1.15-1.91, p-value=0.005). Using renal function at follow up periods immediately prior to and following the PAK procedure, paired results indicated a significant decline in 1/(serum creatinine), median value equal to -5.3% (p-value = 0.009, Signed Rank Test) as compared to the non-PAK cohort which did not show any short term decline in renal function (one-sided p-value = 0.05, Wilcoxon Two-Sample Test). For the separately analyzed outcomes, death censored graft survival and patient survival, the hazard estimates were 1.14 (0.73, 1.78) and 1.26 (0.92, 1.72), respectively. Conclusions The data from the US experience suggest that intermediate term renal allograft survival along with short-term renal function is compromised by a PAK. This data may indicate that the short-term risks of perioperative morbidity and mortality along with alterations in immunosuppression might outweigh the long-term benefits of a pancreas transplant when done in sequence after a living donated kidney transplant.
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Meier-Kriesche et al. (2004) studied this question.