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Transplantation of Pancreatic Islets Into the Kidney Capsule of Diabetic Mice
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Effectiveness of Preceding Solo Kidney Transplantation for Type 1 Diabetes With End-Stage Renal Failure

T Ito1, T Kenmochi1, N Aida1

  • 1Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Aichi, Japan.

Transplantation Proceedings
|December 23, 2018
PubMed

Insights

Preceding kidney transplants for type 1 diabetes patients with end-stage renal failure show lower long-term pancreatic graft survival in pancreas transplantation after kidney transplantation (PAK) compared to simultaneous pancreas and kidney transplantation (SPK). However, patient survival is higher in PAK.

Area of Science:

  • Nephrology
  • Transplant Surgery
  • Endocrinology

Background:

  • Type 1 diabetes with end-stage renal failure often requires kidney transplantation.
  • The effectiveness of preceding kidney transplantation before pancreas transplantation is debated due to graft survival rates.

Purpose of the Study:

  • To compare the effectiveness of simultaneous pancreas and kidney transplantation (SPK) versus pancreas transplantation after kidney transplantation (PAK).
  • To evaluate pancreatic graft survival and patient survival in both SPK and PAK procedures.

Main Methods:

  • A comparative retrospective analysis of SPK (n=232) and PAK (n=39) cases performed until December 2016.
  • Analysis focused on pancreatic graft survival at 1, 3, and 5 years, rejection episodes, and patient survival.

Main Results:

  • SPK demonstrated significantly better long-term pancreatic graft survival (82.8% at 5 years) than PAK (49.1% at 5 years).
  • Rejection was a major cause of graft loss in PAK (62.5% of failures).
  • Rabbit antithymocyte globulin induction improved graft survival by reducing rejection episodes.
  • Five-year patient survival was higher in PAK (96.6%) compared to SPK (88.0%).

Conclusions:

  • While PAK shows lower pancreatic graft survival, it offers superior patient survival.
  • Preceding solo kidney transplantation for type 1 diabetes patients is a viable option if a donor is available, especially considering improved patient survival.

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