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Original Article
April 2013

Low Rates of Short- and Long-term Graft Loss After Kidney-Pancreas Transplant From a Single Center

Author Affiliations

Author Affiliations: Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles.

JAMA Surg. 2013;148(4):368-373. doi:10.1001/2013.jamasurg.261
Abstract

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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