Impact of Pancreas-Kidney Transplants on Renal Allograft

描述(申请者提供)：同时存在的胰腺和肾脏 移植(SPK)是患者日益常见的治疗选择 因I型糖尿病(DM)而患有终末期肾脏疾病。最新研究 提示与肾脏相比，SPK可提高移植肾存活率 单纯移植(KA)。然而，患者的选择可能解释了这一点 由于患者的社会人口学特征和合并症可能影响到的差异 对SPK的考虑。这项研究的目的是评估 患者选择获得SPK与KA以及确定SPK的影响 关于移植肾存活的问题。为了避免选择偏差，比较 SPK和KA受者之间的移植肾存活率将被限制在 等待SPK的患者：约10%的患者在等待SPK SPK因脂肪或创伤后的同种异体胰腺移植而接受KA，或可用 只有一个零抗原不匹配的肾脏。美国疾病控制与预防中心收集了共病 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数据对DM进行横断面研究 1995年4月以后，患者等待SPK或KA。我们会比较一下 患者的社会经济特征、合并症和移植中心 这两个组之间的特点。将使用Logistic回归分析 确定获得SPK的独立决定因素。要确定 SPK对移植肾存活的影响，我们将进行一项回顾性队列研究 在4月后等待SPK和移植SPK或KA的所有患者中 1995年。肾移植存活率在SPK和KA中将使用COX进行比较 比例风险模型，针对患者和移植中心进行调整 特点。

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.