CHARACTERISTICS AND EARLY OUTCOMES OF PATIENTS REFERRED FOR SIMULTANEOUS PANCREAS/KIDNEY TRANSPLANTATION (SPKT) TO A NATIONAL PANCREAS TRANSPLANT UNIT

BYWATER L1, LING J1,2, Polkinghorne K1,2, Mark T1, Kanellis J1,2

1Department of Nephrology, Monash Health, Clayton,, Australia, 2Monash Health Department of Medicine, Monash University, Clayton,, Australia

Background: SPKT in Australia uses recipient criteria that are highly selective compared to those internationally, including a conservative recipient upper‐age limit. Mortality rates due to comorbidity are high, therefore early referral is encouraged (eGFR ≤25ml/min) to allow early identification of issues precluding transplantation.

Aim: To describe the characteristics and early outcomes of patients referred to our unit for SPKT.

Methods: All referrals to our centre from 1/6/2010‐30/6/2018 were reviewed. Patient characteristics including age, dialysis status, eGFR, and geographic origin were examined. Early outcomes (within 6 months after first initial assessment) were assessed including death, in principle acceptance / non‐acceptance, and presence of clinical issues precluding transplantation.

Results: During the study period, 290 referrals were received (48% females, mean age 40.3yrs (SD±8.1)) with 240 (83%) referred from other centres. States referring were VIC 76.9%, SA 14.8%, TAS 7%, NSW/QLD/NT 1.3%. After excluding pancreas without kidney referrals, 75/279 (27%) were already on dialysis at referral. For those pre‐dialysis (73%) mean eGFR was 21ml/min (SD±8).

Of the 260 patients who attended the initial review, 16% were deemed unsuitable while 209 (80%) were accepted in principle. The remaining 4% had an acceptance decision deferred. Median time from referral to appointment was 95 days (range 67‐ 140). Seven (2.4%) died prior to review or soon after initial assessment (mean age 40.3, SD±5.5 years). Sixty‐six (32%) had clinical issues precluding transplantation (eg. heart disease, smoking, overweight, psychosocial issues).

Conclusion: Patients referred for SPK transplantation to our centre are generally young and have a high mortality rate. A significant proportion are referred late, having already commenced dialysis. Many have complex clinical issues needing resolution before they can progress to transplantation.


Biography:

Laura is a third year renal advanced trainee. She has an interest in transplant medicine and immunology.

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