What is the survival rate of the pancreas graft in Simultaneous Pancreas-Kidney (SPK) transplantation?

Pancreas Graft Survival in Simultaneous Pancreas-Kidney (SPK) Transplantation

The 5-year pancreas graft survival rate for recipients of Simultaneous Pancreas-Kidney (SPK) transplants exceeds 85%, which is significantly better than the 55-70% survival rates observed in pancreas transplant alone or pancreas after kidney transplantation. 1

Comparative Pancreas Graft Survival Rates

SPK transplantation demonstrates superior long-term pancreas graft function compared to other types of pancreas transplantation:

• SPK transplantation: >85% 5-year pancreas graft survival 1
• Pancreas transplant alone (PTA): 55-70% 5-year graft survival 1
• Pancreas after kidney (PAK): 55-70% 5-year graft survival 1

More recent data from specific transplant centers shows:

• 1-year pancreas graft survival in SPK of 90% compared to 75% for solitary pancreas transplants 2
• Better long-term pancreas graft survival in SPK compared to non-SPK transplants (statistically significant with log rank .038) 3

Factors Affecting SPK Pancreas Graft Survival

Several factors influence the success of pancreas grafts in SPK transplantation:

• Surgical technique: Evolution from systemic-bladder to portal-enteric drainage has reduced complications 2
• Cold ischemia time: Reduction in cold ischemia time correlates with decreased rates of pancreatic thrombosis 2
• Patient selection: SPK recipients are typically younger (<50 years) and non-obese (<30 kg/m²) without coronary artery disease 1
• Gender matching: Has been shown to influence long-term graft survival 3
• Early pancreas function: Three-month pancreas graft function significantly influences overall survival 4

Clinical Implications and Outcomes

The superior pancreas graft survival in SPK transplantation translates to important clinical benefits:

• Amelioration of problematic hypoglycemia for more than a decade 1
• Improved quality of life through elimination of exogenous insulin and reduction in hypoglycemic episodes 1
• Prevention or reduction of recurrent diabetic nephropathy in the kidney allograft 1
• Potential improvements in diabetic microangiopathy and neuropathy, though evidence is mixed 1

Complications and Considerations

Despite excellent outcomes, SPK transplantation carries specific risks:

• Technical pancreas graft loss: Approximately 10% early technical failure rate 1
• Surgical complications: Reoperation rates as high as 40% due to technical failures and routine complications 1
• Infections: More common in SPK recipients compared to kidney transplantation alone 1
• Acute rejection: Historically higher incidence of acute renal allograft rejection, though newer immunosuppressive regimens have decreased this risk 1

Key Takeaways

1. SPK transplantation offers the best pancreas graft survival rates (>85% at 5 years) among pancreas transplant options
2. The survival advantage depends on successful early pancreas function
3. Despite improvements in surgical techniques and immunosuppression, long-term pancreas graft survival rates have remained relatively stable over recent decades 5
4. Patient selection criteria are important for optimizing outcomes and minimizing complications

For patients with Type 1 diabetes mellitus and end-stage renal disease, SPK transplantation represents an effective treatment option with excellent pancreas graft survival rates and significant clinical benefits.