Islet-kidney, pancreas-kidney transplantation similar for type 1 diabetes

Last Updated: 2015-02-19

By Will Boggs MD

NEW YORK (Reuters Health) - Simultaneous islet-kidney (SIK) transplantation and pancreas-kidney (SPK) transplantation yield similar benefits for patients with type 1 diabetes, researchers from Switzerland report.

"The important message is that both SPK and SIK transplantation are valuable options for patients with type 1 diabetes and end-stage renal failure, and that the better of these two options has to be chosen individually for each patient, if possible by an interdisciplinary team (diabetologist, surgeon, nephrologist, and so on)," Dr. Philipp A. Gerber, from the University Hospital Zurich, told Reuters Health by email.

Dr. Gerber and colleagues compared glycemic control, transplantation-related complications, and function of the transplanted kidney after SPK (or pancreas-after-kidney, PAK) in 94 patients and after SIK (or islet-after-kidney, IAK) in 38 patients.

No patient required kidney retransplantation, but two received pancreas retransplantation and five received islet transplantation after an initial pancreas transplantation.

Insulin independence was significantly higher five years after transplant for SPK/PAK (73.6%) than for SIK/IAK (9.3%), and HbA1c levels decreased to a greater extent after SPK/PAK (from 7.8% to 5.9%) than after SIK/IAK (from 8.0% to 6.5%), according to the February 9 Diabetes Care online report.

Although glomerular filtration rate (GFR) was significantly higher in the SPK/PAK group than in the SIK/IAK group one year after combined transplantation, there was no significant difference between the groups in the decline in renal function of the transplanted kidney at any point during follow-up.

Thirty-nine patients (41.5%) in the SPK/PAK group required early laparotomy (within three months), whereas only 10.5% (four patients) of the SIK/IAK group required a relaparotomy.

Ten-year overall survival was higher after SPK/PAK (88.5%) than after SIK/IAK (65.4%, p=0.004).

"In combined transplantation, the main aim is to have the benefit of kidney transplantation, and an additional effect provided by the pancreas or islets," Dr. Gerber said. "Good glycemic control (also to prevent damage to the transplanted kidney) and reduction of severe hypoglycemia is the main aim, not necessarily insulin independence, which means that a transplantation option like a single islet infusion (which normally does not provide insulin independence, but good glycemic control by some endogenous insulin) may already provide an important benefit to the patient."

"For older patients with many (in particular cardiovascular) comorbidities, we recommend islet transplantation since pancreas transplantation is more invasive and is associated with a higher rate of complications," Dr. Gerber said. "Younger patients can decide what option they prefer; if insulin independence is an important individual aim, pancreas transplantation might be the intervention they prefer, since more patients become insulin independent after this procedure."

For patients with "disabilities that hamper good insulin therapy (e.g., visual impairment)," Dr. Gerber said, "pancreas transplantation might be a better option since insulin independence is important to achieve for such patients."

ProMedica Foundation partially supported this research. The authors declare no conflicts.

SOURCE: http://bit.ly/1vkblxD

Diabetes Care 2015.