High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation.

Simultaneous pancreas and kidney transplantation (SPK) in the setting of end-stage renal disease offers unmatched outcomes in insulin dependent diabetic patients. Donor pool expansion through the transplantation of kidneys with acute kidney injury (AKI) is controversial. 59 SPK transplants were classified by presence of donor AKI, defined as donor terminal creatinine ≥ 1.5x the initial creatinine or donor terminal creatinine > 4.0 mg/dL. Endpoints included graft and patient survival, delayed graft function (DGF), serum creatinine, glomerular filtration rate (GFR), Hemoglobin A1c (HbA1c) and acute rejection. The donor AKI group (n = 35) had significantly higher rates of DGF (38 v. 9%, p = 0.01). There was no difference in creatinine or GFR at 1, 3, 6 and 12 months. HbA1c was comparable at 3, 6 and 12 months. There was no significant difference in the percentage of patients that required anti-diabetic agents after transplant (14 v. 4%, p = 0.56). We observed increased rates of DGF in SPK recipients with donor AKI. However, equivalent outcomes of pancreas and kidney function in both groups were observed. Copyright © 2020 Elsevier Inc. All rights reserved.

Citation

Julia Torabi, Jeffrey Melvin, Alma Rechnitzer, Juan P Rocca, Maria Ajaimy, Luz Lirano-Ward, Yorg Azzi, Cindy Pynadath, Omar Alani, Enver Akalin, Jay A Graham. High terminal creatinine donors should not preclude simultaneous kidney and pancreas transplantation. American journal of surgery. 2021 Apr;221(4):677-680

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PMID: 33012501

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