Abstract: SA-PO006
Outcomes in Simultaneous Pancreas Kidney Transplant in the US Stratified by Induction and Use of Corticosteroids
Session Information
- Transplantation: Clinical Outcomes
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Keys, Daniel, University of Minnesota, Minneapolis, Minnesota, United States
- Riad, Samy M., University of Minnesota, Minneapolis, Minnesota, United States
- Foley, Robert N., University of Minnesota, Minneapolis, Minnesota, United States
Background
Simultaneous Pancreas Kidney (SPK) transplantation is an excellent option for patients with significant renal impairment and diabetes. Outcomes for SPK have improved over the past decade. However, the ideal immunosuppression and induction remains unclear. We sought to analyze outcomes of graft loss and death as stratified by induction and use of low dose corticosteroid.
Methods
Between 2000-2016, 14676 SPK transplants were analyzed in the Scientific Registry of Transplant Recipients (SRTR) database. Groups were made by no induction, IL-2 antagonism, anti-thymocyte globulin (ATG), and alemtuzumab induction with (CCS) and without steroids (CSW). We adjusted for multiple variables including donor age, recipient age, PRA, length of time on dialysis, sex, race, history of heart disease, and HLA mismatches. We analyzed HR for death, kidney and pancreas allograft loss. Adjustment factors included: era; donor and recipient age, sex, race, weight and number of HLA mismatches; recipient time on dialysis, comorbidity, and panel reactive antibodies.
Results
Mean follow up for the cohort was 7.4 years. Regarding induction and steroid strategies, the likelihood of kidney allograft loss was lowest with CCS/ATG ( 13.2%, adjusted hazards ratio [AHR] 0.63 [0.53-0.76], P-Value <0.01, Table 1); pancreas allograft loss was least likely with CSW/ATG (15.9%, AHR 0.61 [0.51-0.73], P-Value <0.01, Table 2); death likelihood was lowest with CCS/ATG (12.7%, 0.8 [0.66-0.96], P-Value 0.02, Table 3).
Conclusion
In 14676 SPK transplants from the US, different induction and maintenance steroid strategies were associated with substantial variationin allograft survival and death. Kidney and pancreas allograft survival were longer with corticosteroids and overall survival was longer with CCS/ATG.