Impact of Pancreas-Kidney Transplants on Renal Allograft

描述（由申请方提供）：同时胰肾 移植（SPK）是患者越来越常见的治疗选择 患有I型糖尿病（DM）导致的终末期肾病。最近的研究 提示与肾移植相比，SPK可改善肾移植物存活 单独移植（KA）。然而，患者的选择可能会解释这一点 差异，因为患者的社会人口统计学和合并症可能影响 考虑到SPK。本研究的目的是评估 患者选择SPK与KA通路，并确定SPK的影响 对移植肾存活率的影响为了避免选择偏差， SPK和KA受者之间的肾移植存活率将被限制在 等待SPK的患者：大约10%的患者 SPK因脂肪或创伤性胰腺同种异体移植物或可用性而接受KA 零抗原不匹配的肾脏USRDS已经收集了 自1995年4月以来的数据。评估患者选择对获得 SPK我们将使用这些国家的数据来进行一项DM的横断面研究 1995年4月后等待SPK或KA的患者。我们将比较 患者社会经济学人口统计学、合并症和移植中心 这两个群体之间的特点。逻辑回归将用于 确定获得社会保护知识的独立决定因素。为了确定 SPK对移植肾存活率的影响，我们将进行一项回顾性队列研究 所有等待SPK并在4月后接受SPK或KA移植的患者中， 1995.将使用考克斯比较SPK和KA的肾移植物存活率 比例风险模型，针对患者和移植中心进行调整 特色

DESCRIPTION (provided by applicant): Simultaneous pancreas kidney transplantation (SPK) is an increasingly common treatment option for patients with end-stage renal disease due to Type I diabetes (DM). Recent studies suggest SPK may improve kidney allograft survival compared to kidney transplantation alone (KA). However, patient selection may account for this disparity since patient sociodemographics and comorbidities likely impact consideration for SPK. The objectives of this study are to assess the impact of patient selection on access to SPK versus KA and to determine the impact of SPK on renal allograft survival. In order to avoid selection bias, the comparison of renal allograft survival between SPK and KA recipients will be limited to patients waitlisted for SPK: approximately 10 percent of patients listed for SPK receive a KA due a fatty or traumatized pancreas allograft, or availability of a zero-antigen mismatch kidney alone. The USRDS has collected comorbidity data since April 1995. To assess the impact of patient selection on access to SPK we will use these national data to conduct a cross-sectional study of DM patients waitlisted for either SPK or KA after April 1995. We will compare patient socioeconomic demographics, comorbidities, and transplant center characteristics between these two groups. Logistic regression will be used to identify independent determinants of access to SPK. To determine the impact of SPK on renal allograft survival, we will conduct a retrospective cohort study of all patients waitlisted for SPK and transplanted with SPK or KA after April 1995. Renal allograft survival in SPK and KA will be compared using Cox proportional hazards models, adjusting for patient and transplant center characteristics.