A group of researchers of the University of Heidelberg, Germany, working on type 1 diabetes and end stage renal disease (ESRD), says that simultaneous kidney transplant with pancreas transplant will increase the long term survival as compared to kidney transplant alone.
End stage renal disease is a major complication of type 1 diabetes. It was previously called as “juvenile” or “insulin-dependent” diabetes.
An analysis has been done by Dr. Morath and his colleagues of Heidelberg, Germany, for long term outcome of patients with type 1 diabetes and ESRD who received a kidney transplant between 1984 and 2000. The analysis involved 11,000 patients.
About 3,500 patients underwent simultaneous transplantation of pancreas and kidney from deceased donor, and remaining patients received only kidney from living or deceased donor.
They evaluated the patient survival and survival of the transplanted kidney for 18 years. The goal was to see how pancreas transplantation adds long term outcomes to kidney transplantation.
They found that the patients receiving simultaneous pancreas kidney transplants had better long term survival. Moreover they found that beyond 10 years, the risk of death was 45% lower than that of living donor kidney group.
Both patient and kidney survival were better for patients undergoing pancreas-kidney transplant or living-donor kidney transplant, compared to deceased-donor kidney transplant. At first, kidney survival rates were best for patients who received living-donor kidney transplants. However, by the end of the follow-up period, kidney survival rate was essentially the same for the pancreas-kidney and living-donor kidney groups.
“Our study shows that functioning pancreas has a benefit for the simultaneously transplanted kidney,” says Dr. Morath. “At the same time, this procedure prolongs the survival of the patient, compared to a patient who received only a kidney transplant.”
“The reduced cardiovascular mortality is most likely due to the normoglycemia [normal blood sugar levels] in patients who received a combined transplant and so the improvement in survival appears to result from a lower rate of cardiovascular deaths in patients undergoing pancreas-kidney transplantation”, says Dr. Morath. “The results show an interaction of different and independent organs—kidney, pancreas, and heart—with respect to survival of the patient.” Moreover Dr. Morath and colleagues believe that “In addition, research should focus on methods which are able to normalize blood glucose [sugar] levels in type 1 diabetic patients, such as islet cell transplantation.”
Till now combined pancreas-kidney transplantation has emerged as an alternative treatment for type 1 diabetics with ESRD. If the pancreas transplant becomes successful and “cures” the diabetec—then no longer they will need to take insulin (although they must take medications to prevent rejection of the transplanted organs).