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February 9, 2005

Survival After Pancreas Transplantation—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2005;293(6):675-676. doi:10.1001/jama.293.6.675-b

In Reply: We agree with questioning assumptions used in retrospective analyses such as ours or that by Dr Gruessner and colleagues.1 Current survival rates in the United States following solitary pancreas transplantation (ie, a pancreas transplant alone for individuals who never lost kidney function or who had kidney function restored by a previous kidney transplant) are approximately 95.3% to 96.5% at 1 year and 84.5% to 85.2% at 4 years. For these rates to represent an improvement over what might have been expected had these individuals not received a transplant, we have asked whether criteria exist to identify a diabetes cohort with preserved kidney function and no contraindications for a transplant (eg, terminal cancer) but with a worse survival than the posttransplant group. No clinical indicators exist to identify such a cohort, because patients with even long-standing diabetes have an excellent survival prognosis as long as they maintain kidney function. Further, recalling that kidney failure is a major predictor for mortality in patients with diabetes, no data exist to suggest that preemptive pancreas transplantation prevents kidney failure. In fact, preemptive pancreas transplantation may worsen renal function (secondary to current immunosuppressive agent–related toxicity).

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