Aim: The aim of this study is to present long-term outcomes of SPKT.
Introduction: Simultaneous pancreas-kidney transplantation (SPKT) is the treatment of choice for patients with end-stage renal failure due to type 1 diabetes mellitus (DM1).
Since the 1980s, pancreas transplant has become the most effective strategy to restore normoglycemia in patients with DM1.
Methods: We performed a retrospective analysis of 73 SPKT recipients who underwent transplantation between 1988 and 2015.
Results: 50.68% of patients were male. During the time of surgery the mean age was 37.8±7.44 years. DM1 was diagnosed average 25±6.08 years before SPKT. For 21.9% it was pre-emptive transplant. 60.9% and 17.19% were on haemodialysis and CADO respectively (the mean dialysis time was 29.05 months). Reoperation due to pancreatic and kidney complications amounted respectively 23.3% vs 8.3%. DGF was observed in 9.6% of kidney graft recipients. Mean HLA - A, – B, – DR mismatches were: 1.42, 1.58, 1.27. All patient received induction of immunosuppression (polyclonal immunoglobulins: ATG/Thymoglobulin – 64% or monoclonal: daclizumab/basiliximab – 36%). Kidney graft survival at 1, 5, 10, 15 years 100%, 97%, 85% and 67%; and pancreas survival is 95%, 92%, 87% and 67% respectively. There was noticed tendency to increase creatinine level (from 1.18 at 1 year to 1.78 at 15 years) and decrease of haemoglobin level (from 13.84 at 1 year to 12.65 at 15 years). Patients with longer time of dialysis were more commonly infected by HCV (p=0.004), more often hospitalized due to cardiovascular complications (p=0.004) and had shorter survival time (p=0.03). HBV infection correlated with longer time of hospitalization during transplantation procedure (p=0.006), more often delay grant function of pancreas (p=0.008), higher serum level of CRP (p=0.04) and more frequent hospitalizations in subsequent years (p=0.003).
Conclusion: Shorter dialysis time improves patient prognosis after SPKTx. HBV and HCV infection is associated with more frequent complications and worse prognosis. Cardiovascular complications are more likely to affect dialysis patients.