An analysis of the survival outcomes of simultaneous pancreas and kidney transplantation compared to live donor kidney transplantation in patients with type 1 diabetes: a UK Transplant Registry study
An analysis of the survival outcomes of simultaneous pancreas and kidney transplantation compared to live donor kidney transplantation in patients with type 1 diabetes: a UK Transplant Registry study
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DOI：
10.1111/tri.12957
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发表时间：
2017-09-01
影响因子：
3.1
通讯作者：
Watson, Christopher J. E.
中科院分区：
文献类型：
--
作者：
Barlow, Adam D.;Saeb-Parsy, Kourosh;Watson, Christopher J. E.
1型糖尿病和终末期肾病（ESRD）患者的移植选择包括死亡供体肾、活体供体肾（LDK）和胰肾联合移植（SPK）。本研究的目的是比较LDK和SPK治疗英国1型糖尿病和ESRD患者的结局。从英国移植登记处获得了2001年1月至2014年12月期间进行的所有SPK（n = 1739）和LDK（n = 385）移植的数据。使用Kaplan-Meier方法计算未校正的患者和肾移植物存活率。采用考克斯比例风险回归对肾移植和患者生存进行多变量分析。单变量分析显示，患者（P = 0.435）或移植肾存活率（P = 0.204）无显著差异。在多变量分析中，LDK/SPK与患者生存率之间无相关性[HR 0.71（0.47-1.06），P = 0.095]。然而，LDK与肾移植失败的总体风险较低相关[HR 0.60（0.38-0.94），P = 0.025]。与LDK受体或胰腺移植失败者相比，胰腺移植功能正常的SPK受体移植肾和患者存活率明显更好。与LDK相比，SPK移植并不赋予总体生存优势。然而，那些具有功能性胰腺的SPK接受者具有显著更好的结果。
Transplant options for patients with type 1 diabetes and end-stage renal disease (ESRD) include deceased donor kidney, live donor kidney (LDK) and simultaneous pancreas-kidney (SPK) transplantation. The aim of this study was to compare outcomes between LDK and SPK for patients with type 1 diabetes and ESRD in the UK. Data on all SPK (n = 1739) and LDK (n = 385) transplants performed between January 2001 and December 2014 were obtained from the UK Transplant Registry. Unadjusted patient and kidney graft survival were calculated using the Kaplan-Meier method. Multivariate analysis of kidney graft and patient survival was performed using Cox proportional hazards regression. There was no significant difference in patient (P = 0.435) or kidney graft survival (P = 0.204) on univariate analysis. On multivariate analysis there was no association between LDK/SPK and patient survival [HR 0.71 (0.47-1.06), P = 0.095]. However, LDK was associated with an overall lower risk for kidney graft failure [HR 0.60 (0.38-0.94), P = 0.025]. SPK recipients with a functioning pancreas graft had significantly better kidney graft and patient survival than LDK recipients or those with a failed pancreas graft. SPK transplantation does not confer an overall survival advantage compared to LDK. However, those SPK recipients with a functioning pancreas have significantly better outcomes.