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Tai DS, Hong J, Busuttil RW, Lipshutz GS. Low Rates of Short- and Long-term Graft Loss After Kidney-Pancreas Transplant From a Single Center. JAMA Surg. 2013;148(4):368–373. doi:https://doi.org/10.1001/2013.jamasurg.261
Author Affiliations: Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles.
Importance Since the 1980s, pancreas transplant has become the most effective treatment strategy to restore euglycemia in patients with type 1 diabetes mellitus. However, technical complications and BK virus nephropathy continue to be important causes of early and late graft loss. These and other complications lead to cited 1- and 3-year graft survival rates of 74% and 67% (pancreas) and 81% and 73% (kidney).
Objective To examine our center's outcomes with pancreas-kidney transplant and early BK virus screening and treatment.
Design Prospective study from August 2004 to January 2012.
Setting University medical center.
Participants Sixty-five patients with type 1 diabetes who underwent simultaneous kidney and pancreas, pancreas after kidney, or pancreas transplant alone at a single center.
Intervention Pancreas transplant.
Main Outcome Measures Pancreas and kidney survival; patient survival; and kidney loss due to BK virus nephropathy.
Results Patient survival at 1, 3, and 5 years was 100%, 98.4%, and 98.4%, respectively. Of 2 early pancreatic allograft losses, 1 was due to thrombosis (1.6%). One- and 5-year pancreas graft survival rates were 95.4% and 92.3%; losses after more than 1 year were due to rejection. Kidney survival rates were 100% and 95.2% at 1 and 5 years; losses were due to nephropathy and noncompliance, with 1 death with function. BK virus incidence was 29.2%, with no graft losses due to BK infection.
Conclusions and Relevance While pancreas transplant can be complicated by early graft loss, our results suggest that excellent outcomes at 5 years can be achieved. Posttransplant BK virus screening and treatment are essential tools to long-term success.
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