Impact of pancreatic allograft function on 1-year survival rates after simultaneous pancreatic-renal transplant

• Published in: Experimental and clinical transplantation Vol. 6; no. 4; p. 301
• Main Authors: Rangel, Erika B, Melaragno, Claudio S, Gonzalez, Adriano M, Linhares, Marcelo M, de Sa, Joao R, Salzedas, Alcides, Medina-Pestana, Jose O
• Format: Journal Article
• Language: English
• Published: Turkey 01-12-2008
• Subjects: Adolescent; Adult; Brazil - epidemiology; Communicable Diseases - mortality; Communicable Diseases - physiopathology; Delayed Graft Function - mortality; Delayed Graft Function - physiopathology; Dopamine - adverse effects; Female; Graft Rejection - mortality; Graft Rejection - physiopathology; Graft Survival; Humans; Kaplan-Meier Estimate; Kidney - physiopathology; Kidney - surgery; Kidney Transplantation - adverse effects; Kidney Transplantation - mortality; Male; Middle Aged; Odds Ratio; Pancreas - physiopathology; Pancreas - surgery; Pancreas Transplantation - adverse effects; Pancreas Transplantation - mortality; Proportional Hazards Models; Retrospective Studies; Risk Assessment; Risk Factors; Sodium - blood; Survival Analysis; Thrombosis - mortality; Thrombosis - physiopathology; Time Factors; Treatment Outcome; Young Adult; Brazil
• ISSN: 1304-0855

Simultaneous pancreatic-renal transplant is an effective treatment for insulin-dependent patients with chronic renal failure. We sought to identify the main influences on pancreatic and patient survival rates after simultaneous pancreas-kidney transplants.
The 1-year patient and pancreas survival rates of 150 patients who had undergone simultaneous pancreas-kidney transplant were analyzed by the Cox proportional hazards regression model and the Kaplan-Meier method. Uni and multivariate analyses were performed in terms of transplant-, recipient-, and donor-related risk factors.
At 1 year, patient and pancreatic allograft survival rates were 82% and 76.7%, respectively. Delayed graft function in the kidney (P = .001, HR 5.41), acute kidney rejection (P = .016, HR 3.36), and intra-abdominal infection (P < .0001, HR 4.15) were the main factors related to 1-year patient survival. Pancreatic allograft survival at 1 year was related to intra-abdominal infection (P < .0001, OR 12.83), vascular thrombosis (P = .002, OR 40.55), acute kidney rejection (P = .027, OR 3.06), donor sodium greater than 155 mEq/L (P = .02, OR 3.27), and dopamine administration exceeding 7.6 microg/kg/min (P = .046, OR 2.85).
Delayed kidney allograft function and intra-abdominal infection had an important effect on both patient and pancreatic allograft survival rates.