Long-term Metabolic Outcomes Post-Simultaneous Pancreas-Kidney Transplantation in Recipients With Type 1 Diabetes

Area of Science:

• Nephrology
• Endocrinology
• Transplantation Medicine

Background:

• Simultaneous pancreas-kidney (SPK) transplantation is a treatment for type 1 diabetes mellitus (T1DM) and end-stage kidney disease (ESKD).
• Immunosuppression post-SPK can have diabetogenic effects, potentially negating glycemic benefits.
• Long-term metabolic trends and cardiovascular risk post-SPK are not well-documented.

Purpose of the Study:

• To evaluate long-term metabolic trends and cardiovascular risk factors after SPK transplantation.
• To assess patient and allograft survival, body mass index (BMI), lipid profiles, insulin sensitivity, and renal function up to 10 years post-transplant.

Main Methods:

• Retrospective analysis of 500 patients with T1DM undergoing SPK transplantation with at least 2-year follow-up.
• Longitudinal monitoring of metabolic parameters (BMI, lipids, insulin sensitivity) and allograft function (eGFR, UACR).

Main Results:

• Excellent patient (97% at 1y, 87% at 10y) and death-censored graft survival (87% at 1y, 80% at 10y).
• Significant BMI increase observed at 1, 3, and 5 years post-transplant.
• Improved lipid profiles and insulin sensitivity by 10 years, but urinary albumin-creatinine ratio increased between 3 and 10 years despite stable eGFR.

Conclusions:

• SPK transplantation demonstrates high patient and graft survival rates.
• Significant long-term weight gain occurs post-SPK, alongside improvements in lipids and insulin sensitivity.
• The observed metabolic changes suggest a potential cardiovascular burden requiring clinical attention in SPK recipients.