The impact of pre-transplant dialysis on simultaneous pancreaskidney versus living donor kidney transplant outcomes

Pre-transplant dialysis is known to affect kidney graft survival. Here, we report the impact of pre-transplant dialysis on patient and graft survival of type 1 diabetic recipients of either a simultaneous pancreaskidney (SPK) or living donor kidney (LDK) transplant. Using the Organ Procurement Transplant Network/United Network for Organ Sharing (OPTN/UNOS) database, 6822 adult type 1 diabetic recipients transplanted through 20002011 were identified. Patients were categorized based on pre-transplant dialysis time (DT): preemptive recipients (P-LDK, n 498; P-SPK, n 1529), recipients with 1 year of DT (01 year DT; LDK n 582, SPK n 1700), and those with 12 years DT (12 year DT; LDK n 301, SPK n 2212). Seven-year patient and kidney survival were examined. Compared with the P-SPK group, both 01 year DT and 12 year DT SPK recipients had lower 7-year patient survival (89, 84 84 respectively; log-rank P-value versus P-SPK 0.01 0.001). For LDK groups, DT 1 year was associated with inferior patient survival (7-year survival 76 versus 87 for P-LDK, P-value versus P-LDK 0.009). Comparing P-LDK to all other SPK groups, there was no significant difference in 7-year patient or kidney survival. Preemptive transplantation is associated with the highest patient survival in both LDK and SPK. Compared with the P-LDK group, DT 1 year is associated with lower patient survival among LDK recipients, but there is no difference in survival with dialysis up to 2 years with SPK. These results highlight the differential impact of DT on LDK and SPK transplantation.