Isolated pancreas rejections do not have an adverse impact on kidney graft survival whereas kidney rejections are associated with adverse pancreas graft survival in simultaneous pancreas kidney transplantation

Irfan Moinuddin, Muhammad Yaqub, Tim Taber, John Powelson, Jonathan Fridell, Asif Sharfuddin

Research output: Contribution to journalArticle

Abstract

Background and objectives: Diabetic Kidney Disease is associated with excessive mortality and morbidity. Simultaneous pancreas kidney transplantation (SPK) significantly improves quality of life and increases life expectancy of uremic diabetic patients. It is not known whether pancreas and kidney rejections in these transplant patients is concordant or discordant. Design, setting, participants, and measurements: We analyzed clinical data on all SPK transplants performed between 2003 and 2014 at Indiana University to assess the impact of isolated or combined pancreas and kidney rejections on patient and allograft outcomes. The primary outcome of interest was kidney graft rejection within 1 year of pancreatic rejection and kidney survival in SPK patients with and without pancreatic rejection. Results: Mean age of patients was 44 ± 9 years; 61.9% were males; 88% were Caucasians. A total of 23.8% of cases had rejection [8.7% pancreatic rejection alone (PA), 4.4% had concordant pancreas and kidney (PK) rejection, and 10.7% had kidney rejection alone(KA)]. PK had a worse effect on kidney graft survival than PA (p = 0.019). Neither pancreas rejection nor kidney rejection had an adverse effect on patient survival. However, both pancreas graft failure and kidney graft failure adversely affected patient survival. Tacrolimus levels were not significantly different in all groups over a 10 year period (p = 0.4584). Conclusions: Concordant pancreas kidney rejection is synergistically deleterious to kidney graft survival. Graft failure, not graft rejection, is adversely associated with patient survival.

Original languageEnglish (US)
Pages (from-to)1-9
Number of pages9
JournalJournal of Nephrology
DOIs
StateAccepted/In press - Sep 16 2017

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Pancreas Transplantation
Graft Survival
Kidney Transplantation
Pancreas
Kidney
Graft Rejection
Transplants
Survival
Diabetic Nephropathies
Tacrolimus
Life Expectancy
Renal Insufficiency
Allografts
Quality of Life

Keywords

  • Concordance
  • Kidney
  • Pancreas
  • Simultaneous
  • Transplantation

ASJC Scopus subject areas

  • Nephrology

Cite this

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title = "Isolated pancreas rejections do not have an adverse impact on kidney graft survival whereas kidney rejections are associated with adverse pancreas graft survival in simultaneous pancreas kidney transplantation",
abstract = "Background and objectives: Diabetic Kidney Disease is associated with excessive mortality and morbidity. Simultaneous pancreas kidney transplantation (SPK) significantly improves quality of life and increases life expectancy of uremic diabetic patients. It is not known whether pancreas and kidney rejections in these transplant patients is concordant or discordant. Design, setting, participants, and measurements: We analyzed clinical data on all SPK transplants performed between 2003 and 2014 at Indiana University to assess the impact of isolated or combined pancreas and kidney rejections on patient and allograft outcomes. The primary outcome of interest was kidney graft rejection within 1 year of pancreatic rejection and kidney survival in SPK patients with and without pancreatic rejection. Results: Mean age of patients was 44 ± 9 years; 61.9{\%} were males; 88{\%} were Caucasians. A total of 23.8{\%} of cases had rejection [8.7{\%} pancreatic rejection alone (PA), 4.4{\%} had concordant pancreas and kidney (PK) rejection, and 10.7{\%} had kidney rejection alone(KA)]. PK had a worse effect on kidney graft survival than PA (p = 0.019). Neither pancreas rejection nor kidney rejection had an adverse effect on patient survival. However, both pancreas graft failure and kidney graft failure adversely affected patient survival. Tacrolimus levels were not significantly different in all groups over a 10 year period (p = 0.4584). Conclusions: Concordant pancreas kidney rejection is synergistically deleterious to kidney graft survival. Graft failure, not graft rejection, is adversely associated with patient survival.",
keywords = "Concordance, Kidney, Pancreas, Simultaneous, Transplantation",
author = "Irfan Moinuddin and Muhammad Yaqub and Tim Taber and John Powelson and Jonathan Fridell and Asif Sharfuddin",
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T1 - Isolated pancreas rejections do not have an adverse impact on kidney graft survival whereas kidney rejections are associated with adverse pancreas graft survival in simultaneous pancreas kidney transplantation

AU - Moinuddin, Irfan

AU - Yaqub, Muhammad

AU - Taber, Tim

AU - Powelson, John

AU - Fridell, Jonathan

AU - Sharfuddin, Asif

PY - 2017/9/16

Y1 - 2017/9/16

N2 - Background and objectives: Diabetic Kidney Disease is associated with excessive mortality and morbidity. Simultaneous pancreas kidney transplantation (SPK) significantly improves quality of life and increases life expectancy of uremic diabetic patients. It is not known whether pancreas and kidney rejections in these transplant patients is concordant or discordant. Design, setting, participants, and measurements: We analyzed clinical data on all SPK transplants performed between 2003 and 2014 at Indiana University to assess the impact of isolated or combined pancreas and kidney rejections on patient and allograft outcomes. The primary outcome of interest was kidney graft rejection within 1 year of pancreatic rejection and kidney survival in SPK patients with and without pancreatic rejection. Results: Mean age of patients was 44 ± 9 years; 61.9% were males; 88% were Caucasians. A total of 23.8% of cases had rejection [8.7% pancreatic rejection alone (PA), 4.4% had concordant pancreas and kidney (PK) rejection, and 10.7% had kidney rejection alone(KA)]. PK had a worse effect on kidney graft survival than PA (p = 0.019). Neither pancreas rejection nor kidney rejection had an adverse effect on patient survival. However, both pancreas graft failure and kidney graft failure adversely affected patient survival. Tacrolimus levels were not significantly different in all groups over a 10 year period (p = 0.4584). Conclusions: Concordant pancreas kidney rejection is synergistically deleterious to kidney graft survival. Graft failure, not graft rejection, is adversely associated with patient survival.

AB - Background and objectives: Diabetic Kidney Disease is associated with excessive mortality and morbidity. Simultaneous pancreas kidney transplantation (SPK) significantly improves quality of life and increases life expectancy of uremic diabetic patients. It is not known whether pancreas and kidney rejections in these transplant patients is concordant or discordant. Design, setting, participants, and measurements: We analyzed clinical data on all SPK transplants performed between 2003 and 2014 at Indiana University to assess the impact of isolated or combined pancreas and kidney rejections on patient and allograft outcomes. The primary outcome of interest was kidney graft rejection within 1 year of pancreatic rejection and kidney survival in SPK patients with and without pancreatic rejection. Results: Mean age of patients was 44 ± 9 years; 61.9% were males; 88% were Caucasians. A total of 23.8% of cases had rejection [8.7% pancreatic rejection alone (PA), 4.4% had concordant pancreas and kidney (PK) rejection, and 10.7% had kidney rejection alone(KA)]. PK had a worse effect on kidney graft survival than PA (p = 0.019). Neither pancreas rejection nor kidney rejection had an adverse effect on patient survival. However, both pancreas graft failure and kidney graft failure adversely affected patient survival. Tacrolimus levels were not significantly different in all groups over a 10 year period (p = 0.4584). Conclusions: Concordant pancreas kidney rejection is synergistically deleterious to kidney graft survival. Graft failure, not graft rejection, is adversely associated with patient survival.

KW - Concordance

KW - Kidney

KW - Pancreas

KW - Simultaneous

KW - Transplantation

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