1
|
Huang AA, Zahid JO, Haji M, Ansari I, Singh M, Dietch Z, Desai A, Ho B, Friedewald JJ, Rohan V. Association of Pre-Existing Type 2 Diabetes on Kidney Transplant Outcomes and Factors Correlating With Survival: A Single-Center Analysis. J Surg Res 2024; 303:268-274. [PMID: 39388991 DOI: 10.1016/j.jss.2024.09.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 08/07/2024] [Accepted: 09/08/2024] [Indexed: 10/12/2024]
Abstract
INTRODUCTION Kidney transplantation (KT) is the treatment of choice for end-stage renal disease. Diabetes mellitus is the most common indication for KT, with most recipients having type 2 diabetes mellitus (T2DM). Previous studies have shown inferior patient survival in T2DM KT recipients. This single-center study aimed to understand the individual factors associated with negative long-term outcomes. METHODS This is a single-center retrospective analysis of adult KT recipients, with and without T2DM from 2012 to 2017 with a follow-up through December 2022. Primary Outcomes were graft loss and patient survival. Univariate, Multivariate Cox regression, and Kaplan-Meier analyses were used to assess KT outcomes. RESULTS We analyzed 1185 patients, 288 (24.3%) with T2DM. T2DM patients tended to be older, 56.6 ± 9.8 versus 47.1 ± 13.7 y. (P < 0.01), male (66.3% versus 58.2% P < 0.001) had a higher body mass index, 31.3 ± 5.4 versus 27.4 ± 5.7 P < 0.01) and less likely to get a living donor transplant (46.5% versus 58.4%, P < 0.01). T2DM patients after KT had a 50% higher risk for graft loss (hazard ratio 1.509, 95% CI 1.15-1.95, P < 0.001) and a 106% higher risk of death (hazard ratio 2.06 (95% CI 1.48-2.87, P < 0.0001). Among the T2DM patients, the most common cause of death was infection (39.9%). The average HbA1c at 1 y after transplant was 7.8%. CONCLUSIONS The present study shows that T2DM is strongly associated with an increased risk of graft loss and death after KT, particularly in older recipients of deceased donor transplants with longer cold ischemia time that experience delayed graft function. This underscores the importance of avoiding delayed graft function in older, type 2 diabetic kidney transplant recipients and prioritizing living donors.
Collapse
Affiliation(s)
- Alexander A Huang
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - Jasmine O Zahid
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - Maaz Haji
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - Ismail Ansari
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - Manasi Singh
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - Zachary Dietch
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - Amishi Desai
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - Bing Ho
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - John J Friedewald
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois
| | - Vinayak Rohan
- Northwestern Medicine Organ Transplantation Center, Chicago, Illinois.
| |
Collapse
|
2
|
Pancreas Transplantation in Minorities including Patients with a Type 2 Diabetes Phenotype. URO 2022. [DOI: 10.3390/uro2040026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background: Prior to year 2000, the majority of pancreas transplants (PTx) were performed as simultaneous pancreas-kidney transplants (SPKTs) in Caucasian adults with end stage renal failure secondary to type 1 diabetes mellitus (T1DM) who were middle-aged. In the new millennium, improving outcomes have led to expanded recipient selection that includes patients with a type 2 diabetes mellitus (T2DM) phenotype, which excessively affects minority populations. Methods: Using PubMed® to identify appropriate citations, we performed a literature review of PTx in minorities and in patients with a T2DM phenotype. Results: Mid-term outcomes with SPKT in patients with uremia and circulating C-peptide levels (T2DMphenotype) are comparable to those patients with T1DM although there may exist a selection bias in the former group. Excellent outcomes with SPKT suggests that the pathophysiology of T2DM is heterogeneous with elements consisting of both insulin deficiency and resistance related to beta-cell failure. As a result, increasing endogenous insulin (Cp) production following PTx may lead to freedom checking blood sugars or taking insulin, better metabolic counter-regulation, and improvements in quality of life and life expectancy compared to other available treatment options. Experience with solitary PTx for T2DM or in minorities is limited but largely mirrors the trends reported in SPKT. Conclusions: PTx is a viable treatment option in patients with pancreas endocrine failure who are selected appropriately regardless of diabetes type or recipient race. This review will summarize data that unconventional patient populations with insulin-requiring diabetes may gain value from PTx with an emphasis on contemporary experiences and appropriate selection in minorities in the new millennium.
Collapse
|
3
|
Pancreas Transplantation for Type 2 Diabetes: A Systematic Review, Critical Gaps in the Literature, and a Path Forward. Transplantation 2022; 106:1916-1934. [PMID: 35576270 DOI: 10.1097/tp.0000000000004113] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pancreas transplantation in patients with type 2 diabetes (T2D) remains relatively uncommon compared with pancreas transplantation in patients with type 1 diabetes (T1D); however, several studies have suggested similar outcomes between T2D and T1D, and the practice has become increasingly common. Despite this growing interest in pancreas transplantation in T2D, no study has systematically summarized the data to date. We systematically reviewed the literature on pancreas transplantation in T2D patients including patient and graft survival, glycemic control outcomes, and comparisons with outcomes in T2D kidney transplant alone and T1D pancreas transplant recipients. We searched biomedical databases from January 1, 2000, to January 14, 2021, and screened 3314 records, of which 22 full texts and 17 published abstracts met inclusion criteria. Full-text studies were predominantly single center (73%), whereas the remaining most often studied the Organ Procurement and Transplantation Network database. Methodological quality was mixed with frequent concern for selection bias and concern for inconsistent definitions of both T2D and pancreas graft survival across studies. Overall, studies generally reported favorable patient survival, graft survival, and glycemic control outcomes for pancreas transplantation in T2D and expressed a need to better characterize the T2D patients who would benefit most from pancreas transplantation. We suggest guidance for future studies, with the aim of supporting the safe and evidence-based treatment of end-stage T2D and judicious use of scarce resources.
Collapse
|
4
|
Shyr BS, Shyr BU, Chen SC, Loong CC, Shyr YM, Wang SE. A comparative study of pancreas transplantation between type 1 and 2 diabetes mellitus. Hepatobiliary Surg Nutr 2021; 10:443-453. [PMID: 34430523 DOI: 10.21037/hbsn-19-422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Accepted: 09/19/2019] [Indexed: 11/06/2022]
Abstract
Background Pancreas transplantation remains the best long-term treatment option to achieve physiological euglycemia and insulin independence in patients with labile diabetes mellitus (DM). It is widely accepted as an optimal procedure for type 1 DM (T1DM), but its application in type 2 DM (T2DM) is not unanimously acknowledged. Methods In total, 146 diabetes patients undergoing pancreas transplantation were included in this study. Clinical data and outcomes were compared between the T1DM and T2DM groups. Results Majority (93%) of the pancreas transplantations in T2DM were for uremic recipients. Complications occurred in 106 (73%) patients, including 70 (48%) with early complications before discharge and 79 (54%) with late complications during follow-up period. Overall, rejection of pancreas graft occurred in 37 (25%) patients. Total rejection rate in T2DM recipients was significantly lower than that in T1DM. The short- and long-term outcomes for endocrine function in terms of fasting blood sugar and hemoglobin A1c levels and graft survival rates are comparable between the T2DM and T1DM groups. Conclusions T2DM is not inferior to T1DM after pancreas transplantation in terms of surgical risks, immunological and endocrine outcomes, and graft survival rates. Therefore, pancreas transplantation could be an effective option to treat selected uremic T2DM patients without significant insulin resistance.
Collapse
Affiliation(s)
- Bor-Shiuan Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang Ming University, Taipei
| | - Bor-Uei Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang Ming University, Taipei.,Division of Transplant Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang Ming University, Taipei
| | - Shih-Chin Chen
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang Ming University, Taipei
| | - Che-Chuan Loong
- Division of Transplant Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang Ming University, Taipei
| | - Yi-Ming Shyr
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang Ming University, Taipei
| | - Shin-E Wang
- Division of General Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang Ming University, Taipei
| |
Collapse
|
5
|
Kukla A, Ventura-Aguiar P, Cooper M, de Koning EJP, Goodman DJ, Johnson PR, Han DJ, Mandelbrot DA, Pavlakis M, Saudek F, Vantyghem MC, Augustine T, Rickels MR. Transplant Options for Patients With Diabetes and Advanced Kidney Disease: A Review. Am J Kidney Dis 2021; 78:418-428. [PMID: 33992729 DOI: 10.1053/j.ajkd.2021.02.339] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 02/21/2021] [Indexed: 02/06/2023]
Abstract
Optimal glycemic control in kidney transplant recipients with diabetes is associated with improved morbidity and better patient and allograft survival. Transplant options for patients with diabetes requiring insulin therapy and chronic kidney disease who are suitable candidates for kidney transplantation should include consideration of β-cell replacement therapy: pancreas or islet transplantation. International variation related to national regulatory policies exists in offering one or both options to suitable candidates and is further affected by pancreas/islet allocation policies and transplant waiting list dynamics. The selection of appropriate candidates depends on patient age, coexistent morbidities, the timing of referral to the transplant center (predialysis versus on dialysis) and availability of living kidney donors. Therefore, early referral (estimated glomerular filtration rate < 30 mL/min/1.73 m2) is of the utmost importance to ensure adequate time for informed decision making and thorough pretransplant evaluation. Obesity, cardiovascular disease, peripheral vascular disease, smoking, and frailty are some of the conditions that need to be addressed before acceptance on the transplant list, and ideally before dialysis becoming imminent. This review offers insights into selection of pancreas/islet transplant candidates by transplant centers and an update on posttransplant outcomes, which may have practice implications for referring nephrologists.
Collapse
Affiliation(s)
- Aleksandra Kukla
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | | | | | - Eelco J P de Koning
- Department of Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - David J Goodman
- Department of Nephrology, St. Vincent's Hospital, Melbourne, Australia
| | - Paul R Johnson
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Duck J Han
- Division of Transplantation, Department of Surgery, Asan Medical Center, Seoul, South Korea
| | - Didier A Mandelbrot
- Division of Nephrology, Department of Medicine, University of Wisconsin, Madison, WI
| | - Martha Pavlakis
- Division of Nephrology, Department of Medicine, Beth Isreal Deaconess Medical Center, Boston, MA
| | - Frantisek Saudek
- Diabetes Center, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Marie-Christine Vantyghem
- CHU Lille, Department of Endocrinology, Diabetology and Metabolism, Inserm U1190, Translational Research for Diabetes, Univ Lille, European Genomic Institute for Diabetes, Lille, France
| | - Titus Augustine
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Biology Medicine and Health, Manchester Academic Health Centre, University of Manchester, Manchester, United Kingdom.
| | - Michael R Rickels
- Division of Endocrinology, Diabetes & Metabolism, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| |
Collapse
|
6
|
Ito T, Kenmochi T, Aida N, Kurihara K, Tomimaru Y, Ito T. Impact of the revision of the law on pancreatic transplants in Japan-An analysis of the Japanese Pancreas Transplants Registry. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 28:353-364. [PMID: 33554417 DOI: 10.1002/jhbp.911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/30/2020] [Accepted: 01/30/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND In Japan, it has been about 10 years since the revision of the law on donating brain-dead organs. The present study compared the outcomes of pancreatic transplant before and after the revision of the law. METHODS The 437 patients who had received pancreas transplantation were divided into two groups according to the time when pancreas transplantation was performed between era 1 (before the revision) and 2 (after the revision), and compared in the patient and pancreas graft survival. RESULTS While the annual number of brain-dead donors was <10 in era 1, and this number significantly increased in era 2 to >50. This resulted in an increased number of pancreas transplantations: >30 cases per year. The comparison data after a propensity score-matched analysis revealed that the death-censored pancreatic graft survival at 1, 3, and 5 years after pancreas transplantation in era 2 was 94.9%, 92.0%, and 92.0%, which, while lacking significance, tended to be better than the values of 90.5%, 83.1%, and 78.2%, respectively, in era 1. CONCLUSIONS The revision of the law on donating brain-dead organs increased the number of pancreas transplantations. Technical improvements in surgery due to increased experience with performing pancreas transplants may help improve pancreatic graft survival.
Collapse
Affiliation(s)
- Taihei Ito
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Naohiro Aida
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Kei Kurihara
- Department of Transplantation and Regenerative Medicine, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Yoshito Tomimaru
- The Japan Pancreas Transplant Registry, The Japanese Pancreas and Islet Transplantation Association, Suita, Japan
| | - Toshinori Ito
- The Japan Pancreas Transplant Registry, The Japanese Pancreas and Islet Transplantation Association, Suita, Japan
| |
Collapse
|