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he Impact of Delayed Graft Function of the Kidney on the Pancreasllograft in Simultaneous Kidney–Pancreas Transplantation

.S. Reddy, R.J. Stratta, R.R. Alloway, A. Lo, and E.E. Hodge, for the PIVOT Study Group

ABSTRACT

It is unclear whether delayed graft function (DGF) of the kidney has any influence onpancreas graft function following simultaneous kidney–pancreas transplantation (SKPT).A subgroup analysis was conducted using data from a multicenter study to determine theimpact of DGF of the kidney on pancreas graft function following SKPT.Methods. Of the 297 SKPT patients, 24 (8%) had DGF of the kidney, defined as theneed for dialysis during the first week posttransplant. Clinical parameters including patientand graft survival, incidence of acute rejection, and pancreas and renal function werecompared between patients with and without DGF at 1 week, and at 1, 3, 6, and 12 monthsposttransplant.Results. Demographic and transplant characteristics were similar between the twogroups except for longer kidney and pancreas cold ischemia times, more males, and moreprimary cytomegalovirus (CMV) exposure in the DGF group (P � .05). No differenceswere seen in patient and graft survival rates, but the incidence of acute renal rejection washigher in patients with DGF (42%) than in those without DGF (15%, P � .001). Morepatients with DGF (25%) received oral hypoglycemic agents at 1-year posttransplant thanin those without DGF (5%, P � .01). At 1 year, the mean serum creatinine was 1.8 mg/dLand 1.4 mg/dL in patients with and without DGF, respectively (P � .01).Conclusions. Patients with DGF of the kidney had a higher incidence of acute renalrejection and received oral hypoglycemic agents more often during the first yearposttransplant compared to those who did not have DGF following SKPT.

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ELAYED graft function (DGF) of the kidney resultsin increased length of hospital stay, higher costs,

ncreased incidence of acute rejection, and inferior long-erm graft survival following kidney transplantation.1–3

owever, it is unclear whether DGF of the kidney has anynfluence on pancreas graft survival and function followingimultaneous kidney–pancreas transplantation (SKPT).he purpose of this study was to determine the impact ofGF of the kidney on pancreas graft function following

KPT by analyzing data from a multicenter SKPT study.

ETHODS

etails of this prospective, randomized, multicenter study haveeen reported previously.4 Of the 297 SKPT recipients enrolled inhe study, 24 (8%) had DGF of the kidney, defined as the need forialysis during the first week posttransplant. Clinical parameters

ncluding patient and graft survival, incidence of acute rejection,ancreas function (fasting blood glucose, HbAlC and C-peptide

evels, requirement for oral hypoglycemic agents), and renal func- 1

041-1345/04/$–see front matteroi:10.1016/j.transproceed.2004.04.052

078

ion (serum creatinine [SCr]) were compared between patients withnd without DGF at 1 week, and at 1, 3, 6, and 12 monthsosttransplant.

ESULTS

atients with or without DGF were similar with respect toemographic and transplant characteristics, except thathere were more males (79% vs 58%, P � .04) and moreatients with primary cytomegalovirus (CMV) exposure

From the Department of General Surgery, Wake Forest Uni-ersity Baptist Medical Center, Winston-Salem, North Carolina.This work was supported by Roche Laboratories, Nutley, New

ersey.Address reprint requests to Robert J. Stratta, MD, Wake

orest University Baptist Medical Center, Department of Generalurgery, Medical Center Boulevard, Winston-Salem, NC 27157-

095. E-mail: rstratta@wfubmc.edu

© 2004 by Elsevier Inc. All rights reserved.360 Park Avenue South, New York, NY 10010-1710

Transplantation Proceedings, 36, 1078–1079 (2004)

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DELAYED GRAFT FUNCTION 1079

38% vs 14%, P � .001) in the DGF group. All patientseceived tacrolimus, mycophenolate mofetil, and steroids asaintenance immunosuppression, and no differences ex-

sted in antibody induction regimens between the tworoups. Patients with DGF had longer cold ischemia timeskidney 18.5 vs 12.8 hours; pancreas 18.5 vs 13.5 hours, P �05) than in those without DGF. At 1 year, the patient,idney, and pancreas graft survival rates were 100%, 96%,nd 87%, respectively, in patients with DGF, and 97%,3%, and 84%, respectively, in patients without DGF (P �S). However, the incidence of acute renal rejection wasigher in DGF patients (42%) than in those without DGF15%, P � .001). The incidence of pancreas allograftejection (4%) was the same in both groups. However, at 1ear, the serum creatinine level was significantly higher andancreatic endocrine function was compromised (Table 1)

n patients with DGF compared with those without DGF.

ONCLUSIONS

atients with DGF were more often male, had a higherncidence of primary CMV exposure, had longer coldschemia, had a higher incidence of acute renal (but notancreas) rejection, and received oral hypoglycemic agentsore often during the first year posttransplant compared to

hose who did not have DGF following SKPT. Kidney andancreas graft survival rates were similar between the tworoups at 1 year, but longer follow-up is needed to deter-

ine whether or not DGF adversely impacts the long-termraft function or survival of either organ following SKPT.

EFERENCES

1. Shoskes DA, Cecka JM: Deleterious effects of delayed graftunction in cadaveric renal transplant recipients independent ofcute rejection. Transplantation 66:1697, 1998

2. Troppmann C, Gillingham KJ, Benedetti E, et al: Delayedraft function, acute rejection, and outcome after cadaver renalransplantation: a multivariate analysis. Transplantation 59:962,9953. Geddes CC, Woo YM, Jardine AG: The impact of delayed

raft function on the long-term outcome of renal transplantation. Jephrol 15:17, 20024. Stratta RJ, Alloway RR, Lo A, et al: Two-dose daclizumab

egimen in simultaneous kidney–pancreas transplant recipients:rimary endpoint analysis of a multicenter, randomized study.ransplantation 75:1260, 2003

Table 1. Kidney and Pancreas Function at 1-yearPosttransplant

DGF(n � 24)

No DGF(n � 273) P Value

ancreas functionFasting blood glucose 110 mg/dL 105 mg/dL NSHbAlC (%) 6.5% 5.8% 0.056Fasting C-peptide (ng/mL) 2.9 3.7 NSOn oral hypoglycemic agents 6/24 (25%) 14/273 (5%) �0.01

idney functionSerum creatinine 1.8 mg/dL 1.4 mg/dL �0.01