Simultaneous pancreas-kidney transplantation is improved by living kidney donation program

Area of Science:

• Transplantation immunology
• Organ donation and procurement
• Diabetic nephropathy management

Background:

• Cadaveric kidney shortages and allocation priorities limit access for diabetic recipients.
• Living kidney donation (LKD) combined with cadaveric pancreas offers an alternative to simultaneous pancreas-kidney transplantation (SPKTx).

Purpose of the Study:

• To evaluate the impact of LKD on expanding the donor pool for SPKTx.
• To assess the effect of LKD on reducing waiting times for SPKTx recipients.
• To compare outcomes of simultaneous cadaveric pancreas-living kidney transplantation (SPLKTx) with SPKTx.

Main Methods:

• Enrolled 80 recipients on the SPKTx waiting list between June 2001 and June 2003.
• Counseled recipients' families regarding LKD; 29 evaluated, 21 scheduled, and 18 completed LKD.
• Compared waiting times and transplantation rates with and without LKD.

Main Results:

• LKD increased the donor pool by 18, expanding it from 33 to 51 recipients (P =.004).
• Median waiting time for SPLKTx was 14 days vs. 95 days for SPKTx (P =.006).
• One-year graft rates were 60% with LKD vs. 42% without (P =.01); two-year survival rates were comparable.

Conclusions:

• LKD effectively expands the kidney donor pool and reduces waiting times for SPKTx.
• SPLKTx increases timely graft access for recipients on the waiting list.
• One-year outcomes for SPLKTx are equivalent to those of SPKTx.