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Presenter: K.V., Ranga, Tucson, USA
Authors: K.V. Ranga, C.S. Desai, A.C. Gruessner, T. Jie, K.M. Khan, C. Parke, F. Maegawa, A. Sussman, M. Madhrira, H. Rilo, B. Kaplan, R.W.G. Gruessner
Improved Long term survival in simultaneous pancreas kidney transplants (spkt) following preemptive transplantation
K.V. Ranga, C.S. Desai, A.C. Gruessner, T. Jie, K.M. Khan, C. Parke, F. Maegawa, A. Sussman, M. Madhrira, H. Rilo, B. Kaplan, R.W.G. Gruessner
University of Arizona Medical Center, Tucson, USA
Pre-emptive kidney transplantation has shown superior graft & patient survival, compared to patients on dialysis at time of transplant. This observation has led to earlier referral of patients with CKD for transplant.
Objective: To examine outcomes of preemptive SPKT to determine survival benefit.
Methods: Retrospective study of IPTR/UNOS database of all 12,600 recipients of primary SPKT performed in the USA between 10/1987 & 12/2005. Univariate & multivariate analyses were performed. The analysis of patient survival dependent on dialysis status was adjusted for recipient age, gender, race, pancreas & kidney functional status, center size & transplant period.
Results: 2899 patients (23%) were transplanted preemptively, with a mean e-GFR of 16+11 ml/min. 76% of patients were on dialysis at time of transplant. Demographic characteristics were not different between patients on or not on dialysis. During the study period, lesser number of patients were transplanted preemptively as time progressed. African American recipients were significantly more often on dialysis than Caucasians. Overall patient survival was significantly higher in preemptively transplanted recipients (p=0.003). Multivariate model showed pre-transplant dialysis carried an increased relative risk (RR) of mortality of 1.22 (p=0.0008). Each year on dialysis increased RR of death by 8% (p=0.0001). Overall kidney graft survival was significantly better in the preemptive group (p=0.0002). mainly due to patient death with functioning graft.
Conclusion: The results show an association between improved patient/ graft survival and preemptive SPKT. It is, therefore, important that potential recipients be referred early for evaluation & listing, increasing their chances for preemptive transplant. Our findings may help in challenging current rules of allocation of SPKT by increasing GFR threshold for listing, & creating a preferential list for SPKT in regions of the country where none exist. In patients without living donors, this is the best way to limit/ avoid dialysis exposure shown to be detrimental to long term outcomes.
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