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A Reassessment of the Survival Advantage of Simultaneous Kidney-Pancreas Versus
Kidney-Alone Transplantation
#MMPMID25757212
Sung RS
; Zhang M
; Schaubel DE
; Shu X
; Magee JC
Transplantation
2015[Sep]; 99
(9
): 1900-6
PMID25757212
show ga
BACKGROUND: Simultaneous kidney and pancreas (SPK) transplantation is an
attractive option for end-stage renal disease patients with type 1 diabetes.
Although SPK transplantation is superior to remaining on dialysis, the survival
advantage for SPK recipients compared to kidney transplantation alone (KTA) is
controversial. METHODS: Using data obtained from the Scientific Registry of
Transplant Recipients, we compared patient and graft survivals for 7308 SPK and
4653 KTA adult patients with type I diabetes transplanted in 1998 to 2009.
Because SPK and KTA recipients are differently selected, comparison groups were
chosen to maximize overlap in the case mixes. Most previous studies contrasted
(unadjusted) Kaplan-Meier survival curves or, if covariate-adjusted, reported
hazard ratios (HRs). Using newer statistical methods, we avoid relying on hazard
ratios (which are seldom of inherent interest) and directly compare
covariate-adjusted survival curves. Specifically, we compare average
covariate-adjusted SPK- and KTA-specific survival curves (and 10-year area under
the curve; ie, restricted mean survival time) to emulate a randomized clinical
trial. RESULTS: Mean restricted mean kidney graft survival time was significantly
greater by 0.18 years (P = 0.045) for SPK compared to KTA. Similarly, patient
survival was 0.17 years greater (P = 0.033) for SPK than KTA. Increased graft
survival was primarily observed in younger SPK recipients. Supplementary analysis
revealed that the SPK hazards were nonproportional, meaning that it would be
difficult to quantify the cumulative effect of SPK through a standard Cox
regression analysis. CONCLUSIONS: Using this novel methodology, we demonstrate
that SPK is associated with statistically but not clinically significant
increases in graft and patient survival.
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