P. H. Pham1,2,4, E. Martinez1,2,3,4, B. Welch2,4, G. Leverson2,4, N. Marka2,4, H. W. Sollinger1,2,4, D. Kaufman1,2,4, R. R. Redfield1,2,4, J. S. Odorico1,2,4 4University Of Wisconsin,Surgery,Madison, WI, USA 1University Of Wisconsin,School Of Medicine And Public Health,Madison, WI, USA 2University Of Wisconsin,Transplantation,Madison, WI, USA 3Baylor University,Dallas, TX, USA
Introduction:
Compared to T1D, in which pancreas transplantation (PTx) is an established effective treatment 1, 2, 3, 4, few studies found similar transplant outcomes including patient, kidney graft, and pancreas graft survival between T1D and T2D SPK recipients5, and suggested that SPK transplantation might be associated with improved patient and kidney survival compared to kidney transplantation alone.6,7,8 However, limited data are available regarding the effect of recipient factors such as age, BMI, or pre-transplant insulin requirements on such outcomes, specifically for T2D recipients.
In this study, we assessed the effects of recipient pre-transplant BMI and insulin requirement on the outcomes of SPK transplantation in T2D patients, and compared these to the impact of those parameters on T1D SPK recipients. The results of this study will not only contribute to the understanding of PTx in T2D recipients, but will also better inform patients and physicians in the decision-making process regarding treatment options.
Methods:
A total of 323 patients who underwent SPK at the University of Wisconsin Hospital between 2006-2017 were assessed for recipient pre-transplant BMI, insulin requirements (Pre-IR), post-transplant diabetes (PTDM) (defined by post-transplant return to an oral hypoglycemic agent (OHA) and/or return to any insulin for > 3 consecutive months) and graft failures (GF) (as reported for resumption of insulin, pancreatectomy, or death). Minimum follow-up was 1 year; except patients who underwent pancreatectomy or failed <90 days, or expired <1 year after transplant. Recipient factors were analyzed to categorize patients as T1D or T2D. Additional variables controlled for included: Donor: age, race, gender, BMI, type (DBD vs. DCD), KDPI, CIT; and Recipient: age, gender, race, donor-recipient CMV/EBV status and induction therapy. Data collection was completed using UW Transplant Database and EHR.
Results:
SPK transplants for T2D increased from 1 per year (3.1% all SPK/year) (2006) to 12 (29.3%) per year (2016). The 323 patients were categorized: 284 T1D and 39 T2D patients based on several clinical parameters. During the follow-up period, 52 patients (16.1% [49 T1D and 3 T2D]) resumed insulin for > 3months, 23 patients (7.1%, all T1D) initiated OHA use post-transplant. Overall, 59 patients (18.2%) experienced GF (pancreatectomy: 18 T1D, 1 T2D; resumption of insulin: 37 T1D, 3 T2D). In T2D patients, BMI and Pre-IR were not significantly associated with GF (pBMI = 0.71; ppre-IR= 0.30) or PTDM (pBMI = 0.58; ppre-IR= 0.54). In T1D patients, neither BMI nor Pre-IR was significantly associated with GF (pBMI = 0.12; ppre-IR= 0.16) or PTDM (pBMI = 0.14; ppre-IR= 0.16).
Conclusion:
In this study, we could not identify a significant association between these pre-transplant parameters and graft failure in general, or PTDM specifically, in T2D SPK recipients. These observations could inform a less restricted approach in T2D recipients.