The Impact of Pancreas Transplantation on Kidney Allograft Survival

被引:22
作者
Browne, S. [1 ]
Gill, J. [1 ]
Dong, J. [1 ]
Rose, C. [1 ]
Johnston, O. [1 ]
Zhang, P. [1 ]
Landsberg, D. [1 ]
Gill, J. S. [1 ]
机构
[1] Univ British Columbia, Div Nephrol, Vancouver, BC V5Z 1M9, Canada
关键词
Glomerular filtration rate; kidney graft survival; kidney graft function; pancreas after kidney; outcomes research; PATIENT SURVIVAL; MORTALITY; FAILURE;
D O I
10.1111/j.1600-6143.2011.03627.x
中图分类号
R61 [外科手术学];
学科分类号
摘要
Whether pancreas after kidney transplantation (PAK) compromises kidney allograft survival, and what pre-PAK glomerular filtration rate (GFR) should be used to select patients for PAK is unclear. We analyzed all (n = 2776) PAK recipients in the United States between 1989 and 2007 and compared their risk of kidney failure to a comparator group of n = 13 635 young adult diabetic kidney only transplant recipients during the same time after accounting for selection bias by the use of a propensity score for PAK in a multivariate time to event analysis. In a secondary analysis, we determined the association of pre-PAK GFR with subsequent kidney allograft survival. Despite an increased risk of death early after pancreas transplantation, PAK recipients had a decreased long-term risk of kidney allograft failure compared to diabetic kidney only transplant recipients HR = 0.89; 95% CI: [0.78-1.00]; p = 0.05. An association of pre-PAK GFR with kidney survival was not evident until 3 years after pancreas transplantation, and patients with a pre-PAK GFR of 30-39 mL/min still attained 10-year post-PAK kidney survival of 69%. We conclude that PAK is associated with improved kidney allograft survival, and pre-PAK GFR 3039 mL/min should not preclude PAK. Expanded use of PAK is warranted.
引用
收藏
页码:1951 / 1958
页数:8
相关论文
共 21 条
[1]  
Ata N, 2007, HACET J MATH STAT, V36, P157
[2]   A comparison of propensity score methods: A case-study estimating the effectiveness of post-AMI statin use [J].
Austin, PC ;
Mamdani, MM .
STATISTICS IN MEDICINE, 2006, 25 (12) :2084-2106
[3]  
Becker BN, 2001, J AM SOC NEPHROL, V12, P2517, DOI 10.1681/ASN.V12112517
[4]   Mortality after kidney transplant failure: The impact of non-immunologic factors [J].
Gill, JS ;
Abichandani, R ;
Kausz, AT ;
Pereira, BJG .
KIDNEY INTERNATIONAL, 2002, 62 (05) :1875-1883
[5]   Mortality assessment for pancreas transplants [J].
Gruessner, RWG ;
Sutherland, DER ;
Gruessner, AC .
AMERICAN JOURNAL OF TRANSPLANTATION, 2004, 4 (12) :2018-2026
[6]  
Hariharan S, 2002, J AM SOC NEPHROL, V13, DOI 10.1681/ASN.V1341109
[7]   Optimal timing for a pancreas transplant after a successful kidney transplant [J].
Humar, A ;
Sutherland, DER ;
Ramcharan, T ;
Gruessner, RWG ;
Gruessner, AC ;
Kandaswamy, R .
TRANSPLANTATION, 2000, 70 (08) :1247-1250
[8]   Death after graft loss: An important late study endpoint in kidney transplantation [J].
Kaplan, B ;
Meier-Kriesche, HU .
AMERICAN JOURNAL OF TRANSPLANTATION, 2002, 2 (10) :970-974
[9]   Reported Isolated Pancreas Rejection Is Associated With Poor Kidney Outcomes in Recipients of a Simultaneous Pancreas Kidney Transplant [J].
Kaplan, Bruce ;
West-Thielke, Patricia ;
herren, Heather ;
Gill, John ;
Knoll, Greg A. ;
Oberholzer, Jose ;
Sankary, Howard ;
Benedetti, Enrico .
TRANSPLANTATION, 2008, 86 (09) :1229-1233
[10]   Pancreas after living donor kidney transplants in diabetic patients: impact on long-term kidney graft function [J].
Kleinclauss, Francois ;
Fauda, Martin ;
Sutherland, David E. R. ;
Kleinclauss, Colette ;
Gruessner, Rainer W. ;
Matas, Arthur J. ;
Kasiske, Bertram L. ;
Humar, Abhinav ;
Kandaswamy, Raja ;
Kaul, Suruchi ;
Gruessner, Angelika C. .
CLINICAL TRANSPLANTATION, 2009, 23 (04) :437-446