J HEDLEY1, P KELLY1, AC WEBSTER1
1Sydney School of Public Health, University Of Sydney, Camperdown, Australia
Aim: To compare patient and graft survival by therapy type among patients with type 1 diabetes and end-stage kidney disease (ESKD).
Background: Therapy options for type 1 diabetics with ESKD include dialysis, kidney transplant alone (KTA) from a deceased or living donor, and simultaneous pancreas-kidney transplant (SPK). There is some evidence internationally that SPK recipients have better survival and kidney graft survival compared to KTA.
Methods: We conducted an inception cohort study from 1984-2016, using data linkage of the Australian and New Zealand Dialysis and Transplant Registry (ANZDATA) and the Australian and New Zealand Pancreas and Islet Transplant Registry (ANZIPTR). We compared survival from ESKD start for all patients and kidney graft survival for KTA and SPK recipients. We used Cox regression with censoring at last known follow-up. We adjusted for age, sex, BMI, remoteness, smoking, cardiovascular disease, treatment history, transplant waiting time, cold ischaemia time, donor characteristics, graft rejections, and presence of a pancreas graft. To meet the proportional hazards assumption, we stratified by age and sex.
Results: We included 3,153 type 1 diabetics, of whom 1,855 (59%) never received a kidney transplant, 427 (14%) first received deceased donor KTA, 173 (5%) received living donor KTA, and 698 (22%) received SPK. Compared to deceased donor KTA, SPK was associated with a 45% reduction in mortality rate (HR 0.55; 95% CI 0.37, 0.82; p<0.001), and a 47% reduction in kidney graft failure rate (HR 0.53; 95% CI 0.35, 0.78; p<0.001).
Conclusions: SPK is the best therapy for type 1 diabetics with ESKD. Patient and kidney graft survival is greater for recipients of SPK compared to dialysis or KTA (deceased or living donor).
Research assistant and biostatistician with a background in health economics