Table 1 –
Outcomes among transplant options for patients with insulin-dependent diabetes and advanced kidney disease
| Study population | Study design | Follow-up | Time on waiting list and/or dialysis | Patient survival | Pancreas/islet graft survival | Kidney graft survival | |
|---|---|---|---|---|---|---|---|
| SPK vs KTA | |||||||
| Lindahl JP (2016)62 | SPK (n=256) vs LDKT (n=230) | Retrospective single center | 7.9 years | Waiting list Not mentioned Dialysis SPK 0.9 years LDKT 0.6 years | Survival on follow-up - SPK 61% - LDKT 44% Mortality risk for SPK (LDKT as reference) - CVD-related (HR 0.63, 95% CI 0.40, 0.99; p= 0.047) - All-cause (HR 0.81, 95% CI 0.57, 1.16; p = 0.25) - CAD-related (HR 0.63, 95% CI 0.36, 1.12; p =0.12) |
- | - |
| Sollinger HW (2009)55 | SPK (n=1000) vs LDKT (n=403) Vs DDKT (n=697) | Retrospective single center | 20 years | Waiting list Not mentioned Dialysis Not mentioned LDKT Not mentioned DDKT Not mentioned | At 10 years SPK : 80% LDKT: 50–60% DDKT: 40–50% Dialysis: follow up only up to 5years | - | At 10 years SPK: 38% LDKT: not mentioned DDKT: not mentioned |
| Barlow A (2017)60 | SPK (n=1739) vs LDKT (n=370) | Retrospective registry analysis | 13 years | Waiting list SPK 0.87 years KTA 0.90 years Dialysis Not mentioned | Better in SPK (with functioning pancreas at 90days) vs LDKT (p=0.042) | - | Delayed graft function (p<0.001) SPK 15.5% LDKT 7.3% Graft survival at 10years (p=0.25) SPK 77% LDKT 80% |
| Fridell JA (2018)61 | SPK (n=19725) vs PAK (n=5636) | Retrospective registry analysis | 10 years | Waiting list SPK 1.2 years KTA No reference Dialysis Not mentioned | At 10 years SPK : 70.3% KTA†: 86.3% | - | PALK vs LDKT 69.8 vs 61.0% PADK vs DDKT 66.0 vs 50.4% |
| SPK vs PAK | |||||||
| Fridell JA (2018)61 | SPK (n=19725) vs PAK (n=5636) | Retrospective registry analysis | 10 years | Waiting list SPK 1.2years PAK 1.3years Dialysis Not mentioned | SPK : 70.3% PAK : 63.2% (P < .001) | SPK 58.7% PALK: 44.4% PADK 41.7% (P < .001) | SPK 61% PALK: 69.8% PADK 66–0% (P < .001) |
| Ventura-Aguiar P (2018)63 | SPK (n=139) vs PALK (n=18) vs PADK (n=28) | Retrospective single center | 10 years | Waiting list SPK 1.6 years PALK 0.5 years PADK 0.3 years Dialysis SPK 2.9 years PALK 1.0 years PADK 2.8 years | SPK vs PALK vs PADK (p>0.05) | PALK and PADK inferior to SPK (p<0.05) | SPK vs PALK vs PADK (p>0.05) |
| Parajuli S (2019)81 | SPK (n=611) vs PALK (n=12) vs PADK (n=12) | Retrospective Single center | 15 years | Waiting list SPK 0.5years PAK 1.2years Dialysis Not mentioned | SPK 68% PAK 71% (p=0.79) | SPK 62% PAK 71% (p=0.38) SPK vs PALK vs PADK (p=0.68) | SPK 66% PAK 50% (p=0.11) SPK vs PALK vs PADK (p=0.59) |
| SIK/IAK vs SPK/PAK | |||||||
| Frank A (2004) 87 | IAK (n=4) vs SPK/ PAK (n=30) | Retrospective single center | IAK (1,4years) SPK/PAK (1,2 years) | Not mentioned | At Fup SPK/PAK 96.6% vs IAK 100% | Graft function (as per C-Peptide secretion) No difference Insulin independence (Fup) Superior for SPK/PAK (p<.04) | No reference |
| Lehmann R (2015) 19 | SIK/IAK (n=38) vs SPK/PAK (n=94) | Retrospective single center | SPK/PAK (5.6 years) SIK/IAK (6.4 years) | Waiting list SPK/PAK 0.9 years SIK/IAK 1.4 years | At 10y SPK/PAK 88.5% vs SIK/IAK 65.4% | Insulin independence (5y) SPK/PAK 73.6% vs SIK/IAK 9.3% | ΔeGFR at 13years SPK/PAK −9.5±23ml/min vs SIK/IAK −13.3±13.8ml/min |
† -
for only those awaiting a PAK
DGF – delayed graft function; eGFR – estimated glomerular filtration rate; IAK – islet-after-kidney; ITA - islet transplant alone; KTA – kidney transplant alone; PADK – pancreas-after-deceased-donor-kidney; PAK – pancreas-after-kidney; PALK – pancreas-after-living-donor-kidney; PTA - pancreas transplant alone; SIK - simultaneous islet-kidney; SPK - simultaneous pancreas-kidney.