Type 2 Diabetes Mellitus Recipients Achieved Excellent Outcomes in Simultaneous Kidney-Pancreas Transplantation Despite High Post-Operative Weight Gain.

Abstract

Background: Simultaneous pancreas-kidney transplantation (SKPTx) is an accepted treatment option for patients with type 1 diabetes mellitus (T1DM) with advaced renal disease but outcomes in type 2 DM (T2DM) are still controversial. Objectives: To compare one-year outcomes of SKP recipients with T1DM and T2DM. Methods: Retrospective analysis of SPK transplant performed between October, 2009 and October, 2012. All patients underwent enteric and portal drainage and received induction with anti-thymocyte globulin followed by maintenance with tacrolimus, mychophenolate mofetil and steroids. Outcomes and baseline characteristics were evaluated using the chi-square test and the two-sample t-test. Results: Fifty-eight patients received a SPKTx: 41% were T1DM and 59% T2DM. No differences were observed in patient gender, race, BMI at transplant, donor age, or incidence of hypertension, hyperlipidemia or heart failure. Patients with T1DM were younger (37.9 vs. 47.1 years p<0.001) and had lower c-peptide level (0.77 vs. 6.25 ng/ml p=<0.001). Length of stay (13.6 vs.16.2 days, p=0.32) and number of readmissions at one year (2.1 vs. 2.1, p=0.95) were also similar between groups. Patients with T2DM experienced an significant increase in their BMI at one year compared with T1DM (T2DM by 2.64 kg/M2 vs. -0.23 kg/M2, p=0.02). Rejection rate at one year was similar between T1DM and T2DM groups (9.1 vs. 12.5%, p=0.68). Patient (97.1 vs. 100%, p=0.38) and graft survival (94.1 vs. 100%, p=0.48) statistically different between T1DM and T2DM groups. Discussion: T2DM recipients of SPKTx can achieve good outcomes comparable to T1DM patients. Increase BMI after SPKTx in T2DM could be a negative risk factor for long-term patient and graft survival and warrants further evaluation.