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Simultaneous Transplant Gives Best Results in Patients With Diabetes, Kidney Disease WASHINGTON, DC -- April 27, 2009 -- For patients with type 1 diabetes who need a kidney transplant, simultaneous pancreas-kidney (SPK) transplantation offers a higher survival rate than other options, but with some increased risks, according to a study published in the online April 30 issue of the Clinical Journal of the American Society of Nephrology. "This study helps patients with type 1 diabetes and their providers decide upon the best transplant treatment option," said Alexander Wiseman, MD, University of Colorado, Denver, Colorado. The study included nearly 6,900 patients with type 1 diabetes undergoing SPK transplantation. When SPK transplant was successful with both organs functional at 1 year, the long-term survival rate was 89%, compared with 80% for patients receiving a kidney from a living donor, and 65% for those receiving a kidney (but not pancreas) from a deceased donor (All SPK transplants came from deceased donors). However, SPK recipients were about 2% more likely to die during the first year after transplantation. There was also a 10% to 15% chance that the transplanted pancreas would fail during the first year. When this happened, the long-term survival rate dropped to 74%. Patients with type 1 diabetes and advanced kidney disease face a difficult decision, according to Dr. Wiseman. "Should they try to get on the waiting list for SPK and assume the greater surgical risk, or should they accept a kidney from a living donor and live with continued diabetes?" If they opt for kidney transplant alone, they then must decide whether to undergo a separate pancreas transplant later on. In the current study, even this option did not lead to better survival than successful SPK transplantation. The new findings help to guide this decision by comparing the benefits and risks of the various transplant options. "Overall, the chances for better long-term success favour the SPK option, particularly if the waiting time for an SPK is not long -- this varies with regions of the United States," said Dr. Wiseman. The study is limited by a lack of information on why the SPK recipients lived longer. One theory is that improved diabetes control helped avoid cardiovascular disease. In addition, although the study provides important new evidence that survival rate is higher after successful SPK transplantation, it does not help in predicting which patients will have a successful SPK transplant. SOURCE: American Society of Nephrology E-mail this page to a friend or colleague! To print, use this version