Abstract
Simultaneous kidney and pancreas (SPK) transplantation is an attractive option for end-stage renal disease patients with type 1 diabetes. Although SPK transplantation is superior to remaining on dialysis, the survival advantage for SPK recipients compared to kidney transplantation alone (KTA) is controversial. Using data obtained from the Scientific Registry of Transplant Recipients, we compared patient and graft survivals for 7308 SPK and 4653 KTA adult patients with type I diabetes transplanted in 1998 to 2009. Because SPK and KTA recipients are differently selected, comparison groups were chosen to maximize overlap in the case mixes. Most previous studies contrasted (unadjusted) Kaplan-Meier survival curves or, if covariate-adjusted, reported hazard ratios (HRs). Using newer statistical methods, we avoid relying on hazard ratios (which are seldom of inherent interest) and directly compare covariate-adjusted survival curves. Specifically, we compare average covariate-adjusted SPK- and KTA-specific survival curves (and 10-year area under the curve; ie, restricted mean survival time) to emulate a randomized clinical trial. Mean restricted mean kidney graft survival time was significantly greater by 0.18 years (P = 0.045) for SP...Continue Reading
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