Outcomes of simultaneous pancreas and kidney transplants based on preemptive transplant compared to those who were on dialysis before transplant

Among kidney transplant recipients, the duration of pre-transplant dialysis is significantly associated with worse post-transplant outcomes. However, data on the outcomes of preemptive simultaneous pancreas and kidney (SPK) is limited. We analyzed primary SPK recipients transplanted between 01/2000 and 12/2017. Patients were divided into two groups based on pre-transplant dialysis history of preemptive versus non-preemptive. Patient and survival of grafts were outcomes of interest. Of the 644 recipients,174 (27%) were preemptive and 470 (73%) were not. Most of the baseline characteristics were similar between the groups. In the univariable analysis, the non-preemptive transplant was associated with 54% increased risk for kidney death censored graft failure (DCGF) (HR:1.54; 95% CI: 1.01-2.35; p=0.05). There was a 29% increased risk after adjustment for confounding factors (HR:1.29; 95% CI: 0.83-2.02; p=0.26), although this association was not statistically significant. Similarly, there was a 16% increased risk of pancreas DCGF in univariable analysis and 1% after adjustment, which was also not statistically significant. When outcomes were based on the duration of pre-transplant dialysis, the duration was not associated with either patient survival or survival of either graft in K-M analysis. In SPK recipients, with pre-transplant dialysis history, there was a tendency towards inferior graft survival, mainly for the kidney more than the pancreas.