Outcomes of Simultaneous Pancreas-Kidney Transplantation in Type 2 Diabetic Recipients

Department of Medicine, David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California 90024, USA.
Clinical Journal of the American Society of Nephrology (Impact Factor: 4.61). 03/2011; 6(5):1198-206. DOI: 10.2215/CJN.06860810
Source: PubMed


Type 2 diabetic patients with end-stage renal disease may receive a simultaneous pancreas-kidney (SPK) transplant. However, outcomes are not well described. Risks for death and graft failure were examined in SPK type 2 diabetic recipients.
Using the United Network for Organ Sharing database, outcomes of SPK transplants were compared between type 2 and type 1 diabetic recipients. All primary SPK adult recipients transplanted between 2000 and 2007 (n=6756) were stratified according to end-stage pancreas disease diagnosis (type 1: n=6141, type 2: n=582). Posttransplant complications and risks for death and kidney/pancreas graft failure were compared.
Of the 6756 SPK transplants, 8.6% were performed in recipients with a type 2 diabetes diagnosis. Rates of delayed kidney graft function and primary kidney nonfunction were higher in the type 2 diabetics. Five-year overall and death-censored kidney graft survival were inferior in type 2 diabetics. After adjustment for other risk factors, including recipient (age, race, body weight, dialysis time, and cardiovascular comorbidities), donor, and transplant immune characteristics, type 2 diabetes was not associated with increased risk for death or kidney or pancreas failure when compared with type 1 diabetic recipients.
After adjustment for other risk factors, SPK recipients with type 2 diabetes diagnosis were not at increased risk for death, kidney failure, or pancreas failure when compared with recipients with type 1 diabetes.

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Available from: Marcelo S Sampaio, Oct 11, 2015
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    • "However, RRT in the United Kingdom remained a very scarce resource and in 1984, at the behest of the Renal Association, investigations revealed a large shortfall in provision of service that stimulated investment in renal services (Feest et al. 1990). At the same time, the acceptance that kidney-alone or simultaneous kidney–pancreas transplantation could significantly improve morbidity and mortality amongst end-stage renal disease (ESRD) patients with diabetes, revolutionised their standard of care (Douzdjian et al. 1996; Sampaio et al. 2011). "
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    ABSTRACT: In some countries, diabetic kidney disease (DKD) is responsible for half of all new patients requiring renal replacement therapy (RRT). Understanding the relationship between early and later stages of DKD is important as it is a preventable cause of renal failure. This review aims to establish the trends in end-stage renal disease (ESRD) due to diabetes in the United Kingdom as the first step in this understanding. Using annual reports from the UK Renal Registry, we summarise the presentation, incidence, prevalence and survival of ESRD patients with diabetes over the last 10-15 years. Between 1995 and 2009, initiation of RRT in diabetes patients increased from 12.3 to 27.6 patients per million population (pmp). These rates are approximately five times less than those of Caucasians in the United States suggesting fundamental differences in early DKD management. Survival of diabetic patients on dialysis has improved such that prevalent numbers on RRT increased from 47 to 117 pmp in a 12-year period. A longer time to prepare patients for RRT is strongly related with better outcomes. In 2002, 23% of all patients with diabetic nephropathy were referred late, within 90 days of RRT start; by 2009, this figure had fallen to 11.2%. Access to renal transplantation, the best form of RRT, has improved with almost 12.5% of new transplants occurring in patients with diabetes compared to 8.3% in 1997. End Stage DKD is more extensively and better treated now than in the late 1990 s and coincides with a time of rapid expansion of UK renal services. More diabetes patients start RRT, patients are referred earlier and survive longer. The prevalence of end-stage DKD is 2.5 times what it was just over 10 years ago. However, across the United Kingdom, there still exists variation in the incidence and outcomes of end-stage DKD. That these figures have grown so much but are still dwarfed by other countries' burden of DKD merits further research. Further prevention of DKD is achievable for the United Kingdom and particularly critical for developing nations who can least afford the expensive 'option' of RRT.
    Journal of Renal Care 02/2012; 38 Suppl 1(s1):12-22. DOI:10.1111/j.1755-6686.2012.00273.x
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    • "The most common causes of ESRD in the United States are diabetes and hypertension [4], while the incidence of nondiabetic ESRD, such as glomerular diseases and cystic diseases, are increasing. Autosomal-dominant polycystic kidney disease (ADPKD) is the most common life-threatening, lethal genetic disease, affecting approximately 7 million people worldwide. "
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    ABSTRACT: End-stage renal disease (ESRD) is a major public health problem. Although kidney transplantation is a viable therapeutic option, this therapy is associated with significant limitations, including a shortage of donor organs. Induced pluripotent stem (iPS) cell technology, which allows derivation of patient-specific pluripotent stem cells, could provide a possible alternative modality for kidney replacement therapy for patients with ESRD. The feasibility of iPS cell generation from patients with a history of ESRD was investigated using lentiviral vectors expressing pluripotency-associated factors. In the present article we report, for the first time, generation of iPS cells from kidney transplant recipients with a history of autosomal-dominant polycystic kidney disease (ADPKD), systemic lupus erythematosus, or Wilms tumor and ESRD. Lentiviral transduction of OCT4, SOX2, KLF4 and c-MYC, under feeder-free conditions, resulted in reprogramming of skin-derived keratinocytes. Keratinocyte-derived iPS cells exhibited properties of human embryonic stem cells, including morphology, growth properties, expression of pluripotency genes and surface markers, spontaneous differentiation and teratoma formation. All iPS cell clones from the ADPKD patient retained the conserved W3842X mutation in exon 41 of the PKD1 gene. Our results demonstrate successful iPS cell generation from patients with a history of ESRD, PKD1 gene mutation, or chronic immunosuppression. iPS cells from autosomal kidney diseases, such as ADPKD, would provide unique opportunities to study patient-specific disease pathogenesis in vitro.
    Stem Cell Research & Therapy 12/2011; 2(6):48. DOI:10.1186/scrt89 · 3.37 Impact Factor
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