TY - JOUR
T1 - Combined Pancreas-kidney Transplantation After Rescue Allocation
T2 - The Eurotransplant Experience: A Retrospective Multicenter Outcome Analysis
AU - Assfalg, Volker
AU - Stocker, Felix
AU - Hüser, Norbert
AU - Hartmann, Daniel
AU - Matevossian, Edouard
AU - Bruchem, Milou van
AU - Vogelaar, Serge
AU - Renders, Lutz
AU - Schmaderer, Christoph
AU - Margreiter, Christian
AU - Deak, Andras
AU - Messner, Franka
AU - Kammer, Michael
AU - Ysebaert, Dirk
AU - Jacobs-Tulleneers-Thevissen, Daniel
AU - Mikhalski, Dimitri
AU - Laecke, Steven van
AU - Gillard, Pieter
AU - Kahl, Andreas
AU - Viebahn, Richard
AU - Riediger, Carina
AU - Jänigen, Bernd
AU - Schmelzle, Moritz
AU - Samson-Himmelstjerna, Friedrich Alexander von
AU - Stippel, Dirk
AU - Harth, Ana
AU - Nitschke, Martin
AU - Koliogiannis, Dionysios
AU - Pascher, Andreas
AU - Hoyer, Joachim
AU - Weinmann-Menke, Julia
AU - Schiffer, Mario
AU - Hinz, Sebastian
AU - Nadalin, Silvio
AU - Lopau, Kai
AU - Huurman, Volkert
AU - Arnol, Miha
AU - Miller, Gregor
N1 - Publisher Copyright:
Copyright © 2025 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2025/8/1
Y1 - 2025/8/1
N2 - Background. Simultaneous pancreas-kidney transplantation (SPKT) is the therapy of choice for selected patients with complicated type 1 diabetes mellitus and end-stage renal disease. Pancreas rescue allocation was implemented in Eurotransplant allocation algorithms to increase organ utilization, concurrently facilitating transplantation of supposedly inferior quality organs. The aim of this study was to examine whether outcomes of SPKT after rescue allocation, which can either be recipient-oriented extended allocation or competitive rescue allocation, were as good as after standard allocation. Methods. This retrospective multicenter analysis of 1504 SPKT performed from 2013 to 2021 evaluated outcomes by allocation type considering survival of patients, pancreas grafts, and kidney grafts. Multivariable analyses further explored the influence of specific donor-, recipient-, and transplant-related variables on outcomes. Results. Multivariable analyses showed no significant differences in SPKT outcome for standard allocation versus either rescue allocation type regarding patient, pancreas graft, and kidney graft survival. Rescue allocation organ donors were older, had higher body mass index, and were more likely to smoke. Rescue allocation had fewer HLA matches. Cold ischemic times of both pancreas and kidneys were longer in competitive rescue allocation but not in recipient-oriented extended allocation. Rescue allocation pancreas recipients had shorter waiting times. Multivariable analyses showed inferior pancreas and kidney graft survival for higher donor age. Higher recipient age correlated with higher mortality despite better pancreas graft survival. Conclusions. SPKT outcome after rescue allocation is comparable with standard allocation in both patient and graft survival. Age of both donors and recipients essentially influences the success of SPKT. (Transplantation 2025;109: 1437–1448).
AB - Background. Simultaneous pancreas-kidney transplantation (SPKT) is the therapy of choice for selected patients with complicated type 1 diabetes mellitus and end-stage renal disease. Pancreas rescue allocation was implemented in Eurotransplant allocation algorithms to increase organ utilization, concurrently facilitating transplantation of supposedly inferior quality organs. The aim of this study was to examine whether outcomes of SPKT after rescue allocation, which can either be recipient-oriented extended allocation or competitive rescue allocation, were as good as after standard allocation. Methods. This retrospective multicenter analysis of 1504 SPKT performed from 2013 to 2021 evaluated outcomes by allocation type considering survival of patients, pancreas grafts, and kidney grafts. Multivariable analyses further explored the influence of specific donor-, recipient-, and transplant-related variables on outcomes. Results. Multivariable analyses showed no significant differences in SPKT outcome for standard allocation versus either rescue allocation type regarding patient, pancreas graft, and kidney graft survival. Rescue allocation organ donors were older, had higher body mass index, and were more likely to smoke. Rescue allocation had fewer HLA matches. Cold ischemic times of both pancreas and kidneys were longer in competitive rescue allocation but not in recipient-oriented extended allocation. Rescue allocation pancreas recipients had shorter waiting times. Multivariable analyses showed inferior pancreas and kidney graft survival for higher donor age. Higher recipient age correlated with higher mortality despite better pancreas graft survival. Conclusions. SPKT outcome after rescue allocation is comparable with standard allocation in both patient and graft survival. Age of both donors and recipients essentially influences the success of SPKT. (Transplantation 2025;109: 1437–1448).
UR - https://www.scopus.com/pages/publications/105007159566
UR - https://www.mendeley.com/catalogue/48a4602f-f4ff-3f1f-9c19-fbfc01c62ddb/
U2 - 10.1097/TP.0000000000005354
DO - 10.1097/TP.0000000000005354
M3 - Journal articles
C2 - 40059095
AN - SCOPUS:105007159566
SN - 0041-1337
VL - 109
SP - 1437
EP - 1448
JO - Transplantation
JF - Transplantation
IS - 8
ER -
