Pancreas After Living Donor Kidney Versus Simultaneous Pancreas-Kidney Transplant: An Analysis of the Organ Procurement Transplant Network/United Network of Organ Sharing Database

One of the alternative options to simultaneous pancreas-kidney transplantation (SPKT) for type I diabetics with renal failure is sequential transplant of a living donor kidney followed by a deceased donor pancreas transplant (pancreas after living donor kidney transplant [PALK]). We retrospectively compared the outcomes of SPKT versus PALK. Adults (age 18-59 years) with type I diabetes who were waitlisted for kidney-pancreas and received a SPKT or PALK between 2000 and 2007 were studied. We compared patient, kidney graft, and pancreas graft survival. Multivariate analysis was performed, and the results were expressed as hazard ratios (HRs) of graft loss and death of PALK, with SPKT as a reference. Of 11,966 patients who received a kidney transplant, 807 received a PALK and 5580 received a SPKT. Median time to pancreas from kidney transplant was 336 (25%-75%: 185-602 days) days. Average hospital stay for SPKT recipients was 13.2+/-15 days, whereas for PALK recipients was 5.7+/-4 days and 9.5+/-8 days for kidney and pancreas transplants, respectively. After controlling for confounding factors, patients receiving PALK had better patient survival (HR 0.52; 95% confidence interval [CI] 0.39-0.70) and kidney survival (HR 0.48; 95% CI 0.39-0.60) but worse pancreas survival (HR 1.37; 95% CI 1.16-1.62) compared with SPKT. Among those who were waitlisted for a kidney-pancreas transplant, 53% received a kidney-pancreas transplant. Of those who received a kidney-pancreas transplant, 87% patients underwent SPKT and 13% underwent PALK. PALK was associated with better kidney graft and patient survival compared with SPKT. We found an inferior pancreas graft survival and longer total transplant hospitalization in PALK.