Simultaneous Kidney-Pancreas Transplantation for End-Stage Renal Disease Patients with Insulin-Dependent Diabetes and Detectable C-Peptide

Introduction. There is controversy regarding the place of simultaneous pancreas-kidney (SPK) transplantation in end-stage renal disease (ESRD) patients with insulin-dependent diabetes mellitus (IDDM) and detectable c-peptide. We sought to compare outcomes of recipients with and without pretransplantation c-peptide. Methods. This retrospective single-center review included consecutive primary SPK transplantations performed between September 2007 and May 2010. Demographic characteristics and outcomes were compared between recipients with and without pretransplantation c-peptide. Results. Seven of 25 (28%) consecutive SPK transplant recipients with a diagnosis of IDDM and ESRD had detectable c-peptide prior to transplantation. The mean c-peptide level was 6.3 +/- 6.1 ng/mL. For those recipients with and without c-peptide, mean age at diagnosis of IDDM (12.4 +/- 7.8 vs 17.1 +/- 6.6 years; P = not significant [NS]), duration of IDDM prior to transplantation (30 +/- 10 vs 23 +/- 9 years; P = NS), and body mass index (25.9 +/- 4.5 vs 26.7 +/- 4.5 kg/m(2); P = NS) were equivalent between the groups. With a median follow-up of 17 months (range, 3-35 months) there was 1 graft loss (due to cardiovascular death) among the 25 patients. At the most recent follow-up, for recipients with and without c-peptide, both the mean serum creatinine (1.3 +/- 0.6 vs 1.0 +/- 0.2 ng/mL; P = NS) and the mean HbA1c level (5.3 +/- 0.4 vs 5.3 +/- 0.5; P = NS) were equivalent between the groups. Conclusion. For nonobese ESRD patients diagnosed with IDDM at a young age, the presence of detectable c-peptide should not influence the decision to proceed with SPK transplantation.