Multi-Centre UK Analysis of Simultaneous Pancreas and Kidney (SPK) Transplant in Recipients With Type 2 Diabetes Mellitus

90% of the UK diabetic population are classified as T2DM. This study aims to compare outcomes after SPK transplant between recipients with T1DM or T2DM. Data on all UK SPK transplants from 2003-2019 were obtained from the NHSBT Registry (n = 2,236). Current SPK transplant selection criteria for T2DM requires insulin treatment and recipient BMI < 30 kg/m2. After exclusions (re-transplants/ambiguous type of diabetes) we had a cohort of n = 2,154. Graft (GS) and patient (PS) survival analyses were conducted using Kaplan-Meier plots and Cox-regression models. Complications were compared using chi-squared analyses. 95.6% of SPK transplants were performed in recipients with T1DM (n = 2,060). Univariate analysis showed comparable outcomes for pancreas GS at 1 year (p = 0.120), 3 years (p = 0.237), and 10 years (p = 0.196) and kidney GS at 1 year (p = 0.438), 3 years (p = 0.548), and 10 years (p = 0.947). PS was comparable at 1 year (p = 0.886) and 3 years (p = 0.237) and at 10 years (p = 0.161). Multi-variate analysis showed comparable outcomes in pancreas GS (p = 0.564, HR 1.221, 95% CI 0.619, 2.406) and PS(p = 0.556, HR 1.280, 95% CI 0.563, 2.911). Comparable rates of common complications were demonstrated. This is the largest series outside of the US evaluating outcomes after SPK transplants and shows similar outcomes between T1DM and T2DM recipients. It is hoped dissemination of this data will lead to increased referral rates and assessment of T2DM patients who could benefit from SPK transplantation.

O002 Diabetes-associated HLA donor genotypes and pancreas transplant outcomes

Introduction

The genotypes HLA DR3/DR4, DR3/DR3, DR4/DR4 are associated with a predisposition to diabetes. This study evaluated UK recipient outcomes after pancreas transplantation from donors with a diabetes-associated genotypes.

Methods

Data on all UK pancreas transplants from 2004–2019 was obtained from the NHSBT-UK Registry, n=2,938. HLA-DR type was recorded for all organ donors. Re-transplants and those missing patient (PS) or graft (GS) survival were excluded, resulting in a final cohort of n=2,661. We further delineated our categories into SPK, PTA and PAK as a previous study suggested different recipient categories may be adversely affected. Univariate analyses were conducted using Kaplan-Meier plots and multi-variate analysis using Cox-regression models. Complications were analysed using chi-squared analyses.

Results

The majority of grafts were from donors not associated with diabetes genotypes (90.1%, n=2397) whereas 5.4%(n=145) came from HLA DR3/DR4 donors, 1.6%(n=43) from DR3/DR3 and (n=76)2.9% from DR4/DR4. Comparable outcomes for GS at 1yr (SPK p=0.980, PTA p=0.759, PAK p=0.244) and 3yrs (SPK p=0.708, PTA p=0.744, PAK p=0.275) and PS at 1yr (SPK p=0.553, PTA p=0.527, PAK p=0.756) and 3yrs (SPK p=0.728, PTA p=0.928, PAK p=0.424) were seen. Multivariate analysis also showed no statistically significant difference in GS (p=0.604, HR 1.041, 95%CI 0.895, 1.211) or PS (p=0.623, HR 1.045, 95%CI 0.876, 1.248). There were comparable complication rates.

Conclusion

This multicentre UK study has found comparable survival outcomes and complication rates within our donor-HLA-genotype groups. We do not believe that the presence or absence of a diabetes associated HLA-genotype influences outcomes for any category of pancreas transplant.

Take-home message

We do not believe that the presence or absence of a diabetes-associated HLA-genotype influences outcomes for any category of pancreas transplant.