ORIGINAL ARTICLE
Predictors of 10-Year Pancreas Allograft Survival After Simultaneous Pancreas and Kidney Transplantation Niall F. Davis, PhD, John P. Burke, PhD, Rory Kelly, MD, William P. Shields, MD, Farhad Kheradmand, MD, Antonio Zimmermann, MD, Ponnusamy Mohan, MD, and David P. Hickey, MD Objective: This study aimed to identify the preoperative, perioperative, and postoperative factors affecting 10-year pancreas allograft survival after simultaneous pancreas and kidney (SPK) transplantation. Methods: Analysis was performed on a prospectively maintained database of 56 SPK transplants consecutively performed between January 1992 and October 2002. The definition cutoff points of specific variables were obtained by the receiver operating characteristic curve and multiple logistic regression analyses that were performed to determine the predictors of pancreas allograft survival after 10 years. Results: In total, 44 (79%) patients had an overall survival of more than 10 years, and the overall 10-year pancreas allograft survival rate was 57% (n = 32/56). The significant predictors for pancreas allograft failure in 10 years and above were kidney allograft failure (P = 0.04), serum creatinine 1 year postoperatively (P = 0.002), and serum hemoglobin A1c (HbA1c) level 2 years postoperatively (P = 0.003). A serum creatinine cutoff value of more than 129 Kmol/L at 1 year was 87.5% sensitive and 70% specific for predicting pancreas allograft failure at 10 years. Serum HbA1c of more than 5.6% at 2 years was 85.7% sensitive and 62.5% specific for predicting pancreas allograft failure at 10 years. On multivariate analysis, 129 Kmol/L and above of serum creatinine and more than 5.6% of serum HbA1c were the independent predictors of pancreas allograft failure at 10 years. Conclusions: These findings may provide important information for identifying patients at risk for long-term pancreas allograft failure after SPK transplantation. Key Words: long-term pancreas survival, simultaneous pancreas and kidney transplantation, transplant, transplantation Abbreviations: auROC - area under the receiver operating characteristic, CMV - cytomegalovirus, CYA - cyclosporin, HbA1c - hemoglobin A1c, IDDM - insulin-dependent diabetes mellitus, NPV - negative predictive value, PPV - positive predictive value, ROC receiver operating characteristic, SPK - simultaneous pancreas and kidney (Pancreas 2014;43: 750Y754)
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imultaneous pancreas and kidney (SPK) transplantation is now the treatment of choice for patients with type 1 insulindependent diabetes mellitus (IDDM) and end-stage renal disease. Long-term results after SPK have improved, and the current patient survival rates for SPK transplantation after 1, 3, and 5 years are 95%, 91%, and 86%, respectively.1,2 In addition, the 1-, 3-, and 5-year pancreas allograft survival rates after SPK transplantation are 86%, 79%, and 71%, respectively.1,2
From the Department of Transplant Surgery, Beaumont Hospital, Dublin, Ireland. Received for publication July 18, 2013; accepted November 19, 2013. Reprints: Niall F. Davis, PhD, Department of Transplant Surgery, Beaumont Hospital, Beaumont Rd, Dublin 9, Co. Dublin, Ireland (e
Predictors of 10-Year Pancreas Allograft Survival After Simultaneous Pancreas and Kidney Transplantation Niall F. Davis, PhD, John P. Burke, PhD, Rory Kelly, MD, William P. Shields, MD, Farhad Kheradmand, MD, Antonio Zimmermann, MD, Ponnusamy Mohan, MD, and David P. Hickey, MD Objective: This study aimed to identify the preoperative, perioperative, and postoperative factors affecting 10-year pancreas allograft survival after simultaneous pancreas and kidney (SPK) transplantation. Methods: Analysis was performed on a prospectively maintained database of 56 SPK transplants consecutively performed between January 1992 and October 2002. The definition cutoff points of specific variables were obtained by the receiver operating characteristic curve and multiple logistic regression analyses that were performed to determine the predictors of pancreas allograft survival after 10 years. Results: In total, 44 (79%) patients had an overall survival of more than 10 years, and the overall 10-year pancreas allograft survival rate was 57% (n = 32/56). The significant predictors for pancreas allograft failure in 10 years and above were kidney allograft failure (P = 0.04), serum creatinine 1 year postoperatively (P = 0.002), and serum hemoglobin A1c (HbA1c) level 2 years postoperatively (P = 0.003). A serum creatinine cutoff value of more than 129 Kmol/L at 1 year was 87.5% sensitive and 70% specific for predicting pancreas allograft failure at 10 years. Serum HbA1c of more than 5.6% at 2 years was 85.7% sensitive and 62.5% specific for predicting pancreas allograft failure at 10 years. On multivariate analysis, 129 Kmol/L and above of serum creatinine and more than 5.6% of serum HbA1c were the independent predictors of pancreas allograft failure at 10 years. Conclusions: These findings may provide important information for identifying patients at risk for long-term pancreas allograft failure after SPK transplantation. Key Words: long-term pancreas survival, simultaneous pancreas and kidney transplantation, transplant, transplantation Abbreviations: auROC - area under the receiver operating characteristic, CMV - cytomegalovirus, CYA - cyclosporin, HbA1c - hemoglobin A1c, IDDM - insulin-dependent diabetes mellitus, NPV - negative predictive value, PPV - positive predictive value, ROC receiver operating characteristic, SPK - simultaneous pancreas and kidney (Pancreas 2014;43: 750Y754)
S
imultaneous pancreas and kidney (SPK) transplantation is now the treatment of choice for patients with type 1 insulindependent diabetes mellitus (IDDM) and end-stage renal disease. Long-term results after SPK have improved, and the current patient survival rates for SPK transplantation after 1, 3, and 5 years are 95%, 91%, and 86%, respectively.1,2 In addition, the 1-, 3-, and 5-year pancreas allograft survival rates after SPK transplantation are 86%, 79%, and 71%, respectively.1,2
From the Department of Transplant Surgery, Beaumont Hospital, Dublin, Ireland. Received for publication July 18, 2013; accepted November 19, 2013. Reprints: Niall F. Davis, PhD, Department of Transplant Surgery, Beaumont Hospital, Beaumont Rd, Dublin 9, Co. Dublin, Ireland (e
