Over 25 Years of Simultaneous Pancreas Kidney Transplantation in New Zealand

Simultaneous pancreas kidney (SPK) transplant remains the gold standard treatment for patients with Type 1 diabetes mellitus (T1DM) and end-stage renal disease (ESRD) offering independence from insulin and dialysis. We describe the outcomes of New Zealand's SPK transplant programme since its inception.

This retrospective audit included consecutive patients who received a SPK transplant for ESRD secondary to T1DM from 1998 until the end of 2024. Clinical data were obtained from Auckland City Hospital where all SPK transplants in New Zealand are performed, as well as regional hospitals where patients are followed up. Data pertaining to patient and graft survival as well as short- and long-term complications were collected and analysed.

Eighty patients were included in this audit with a median of three transplants per year. Patient survival at 5 and 10 years was 97.3% and 87.7%, respectively. Pancreas survival at 5 years was 88.2%, while kidney survival was 93.4%. 20-year outcomes for patient, pancreas and kidney survival were 63.8%, 50.3% and 51.2%, respectively. There were 9 (11.1%) cases of graft thrombosis. Biopsy-proven graft rejection occurred in 30 (37%) patients with a similar incidence in transplanted kidneys and pancreases. Fifteen (18.5%) patients required relaparotomy within 1 year. Most SPK transplant recipients (81.5%) were NZ Europeans.

Our long-term results demonstrated the safety and efficacy of our SPK programme despite relatively low numbers. Further expansion in line with other centres is necessary to address inequities and improve access to treatment for New Zealanders living with diabetes.