Beyond Survival: Factors Driving Textbook Outcome After Simultaneous Pancreas-Kidney Transplantation-A Retrospective...

Area of Science:

• Nephrology
• Transplantation Surgery
• Endocrinology

Background:

• Simultaneous pancreas-kidney (SPK) transplantation is a standard treatment for type 1 diabetes mellitus with end-stage renal disease.
• Textbook Outcome (TO) serves as a benchmark for optimal SPK results, assessing perioperative and long-term quality indicators.
• This study investigates factors predicting failure to achieve TO post-SPK.

Purpose of the Study:

• To identify predictors of Textbook Outcome (TO) failure in simultaneous pancreas-kidney (SPK) transplant recipients.
• To analyze the association between achieving TO and long-term patient survival after SPK.
• To provide insights for optimizing donor selection and perioperative management in SPK transplantation.

Main Methods:

• Retrospective analysis of 119 SPK recipients from 1980-2022.
• TO defined by IQTIG criteria: patient survival ≥ 3 years, insulin independence at discharge, kidney function at discharge (GFR ≥ 20 mL/min), insulin-free survival ≥ 3 years, and sustained kidney function ≥ 3 years.
• Logistic regression and Kaplan-Meier analysis were used to identify predictors of TO failure and assess long-term survival.

Main Results:

• 52% of 92 eligible patients achieved TO.
• Non-TO patients had significantly older donors (median 30 vs. 25.5 years), older recipients (44 vs. 39 years), longer kidney cold ischemia time (CIT; 13.0 vs. 9.7 h), and more pancreatic complications.
• Multivariate analysis identified donor age (OR 1.050) and kidney CIT (OR 1.180) as independent predictors of TO failure, with optimal cut-offs at donor age ≤ 37 years and kidney CIT ≤ 11.5 h.

Conclusions:

• Younger donor age and shorter kidney CIT are independent predictors of achieving Textbook Outcome (TO) after SPK transplantation.
• Achievement of TO is significantly associated with superior long-term survival rates (15-year survival).
• Optimizing donor selection and perioperative management are crucial for improving SPK transplant outcomes and patient survival.