肾移植患者术后外周血CD4+CD25+调节性T细胞的检测及其与瘦素水平的相关性

目的:了解肾移植患者术后外周血中CD4 CD25 调节性T细胞的比例和瘦素水平的变化及其临床意义,探讨CD4 CD25 调节性T细胞与瘦素水平的相关性。方法:应用放射免疫方法检肾移植患者及健康对照者外周血中瘦素的水平,流式细胞术检测外周血中CD4 CD25 调节性T细胞占CD4 T细胞的比例。结果:移植近期组(1年)与对照组患者血浆中瘦素浓度比较无差异,但移植远期组的瘦素浓度(2.5年)高于对照组和移植近期组。且外周血中CD4 CD25 调节性T细胞的比例与瘦素呈显著负相关(r=-0.83,P<0.01)。结论:肾移植术后的远期高瘦素血症可能对CD4 CD25 调节性T细胞具有负性调节作用,也许不利于移植耐受的维持。     

载脂蛋白E基因多态性对肾移植前后血脂水平的影响

目的：探讨载脂蛋白(Apo)E基因多态性对肾移植患者移植前后血脂水平的影响。方法：采用聚合酶链反应-限制性片段长度技术检测105例肾移植患者ApiE基因多态性，同时测定移植前及移植后3个月、6个月、1年、1．5年时的血脂水平，并设健康志愿者对照组。结果：移植组术后3个月血脂水平即显著增高，6个月及1年时进一步升高，1．5年时有下降趋势。移植前血清胆固醇(TC)、甘油三酯(TG)高于正常者仅占2．9％、7．6％，3个月后显著增高至28．6％、46．7％，6个月时升高至40．0％、59．0％，1年时为42．9％、62．9％，显著高于移植后3个月时的水平；肾移植组与对照组在ApoE基因型、等位基因分布频率等方面的差异无显著性。ApoE基因多态性对血脂水平的影响表现为，对照组TC、TG、低密度脂蛋白胆固醇(LDLC)、ApoA1、ApoB水平依基因型ε2／2 ε2／3、ε3／3、ε3／4 ε4／4的顺序递增，高密度脂蛋白胆固醇(HDLC)则呈递减；移植组术前表现为TC、TG、LDLC水平依上述顺序递增，移植后则表现为TG、ApoE水平依此顺序递减，不同基因型间TC等指标的差异无显著性。结论:ApoE基因多态性对移植前后血脂水平有不同的影响，移植前等位基因ε4携带者的TC、LDLC、TG水平显著增高，移植后等位基因ε2携带者的TG、ApoE水平显著增高。     

存活10年以上并长期服用环孢素A的肾移植受者的临床研究

目的 研究肾移植后1年时血环孢素A(CsA)浓度对存活超过10年的肾移植受者的影响.方法 以肾移植后存活10年以上、移植肾有功能、长期服用CsA并规律随访的380例肾移植受者为对象,380例肾移植后均采用以CsA为主的免疫抑制方案.根据肾移植术后1年时血CsA浓度将受者分为5组:组1的血CsA浓度＞0.208μmol/L(1μmol/L=1201.9 μg/L);组2的血CsA浓度为0.166～0.208μmol/L;组3的血CsA浓度为0.125～0.166μmol/L;组4的血CsA浓度为0.083～0.125 μmol/L;组5的血CsA浓度＜0.083 μmol/L.分析各组术后1年、5年和10年时的收缩压(SBP)、舒张压(DBP)、血肌酐(SCr)、尿酸(UA)、胆固醇(CH)、三酰甘油、丙氨酸转氨酶、直接胆红素(DBil)和胆红素总量(TBil)、白蛋白(Alb)、Hb、WBC和有无蛋白尿.结果 术后5年时,组1和组2的SBP明显高于组3、组4和组5(P＜0.05);组5的UA明显低于其他4组(P＜0.05),而Alb明显高于其他4组(P＜0.05);组4和组5的尿蛋白阳性率明显低于其他3组.术后10年时,除个别组的SBP、DBP、DBil、TBil和CH外,各组间其他指标的差异均无统计学意义(P＞0.05).无论是术后5年还是10年,各组间SCr的差异均无统计学意义.结论 肾移植后1年时血CsA浓度对移植肾的远期(10年)功能影响不大,但血CsA浓度较高者(＞0.166μmol/L),肾移植后5年、10年时高血压发生率、高尿酸发生率和尿蛋白阳性率较高.     

Ⅰ型糖尿病肾病患者肾移植前行胎胰组织移植的治疗效果观察

目的　研究胎胰移植对I型糖尿病肾病患者行肾移植的影响。方法　我院近 2年多来在I型糖尿病患者肾移植手术前行胎胰组织移植 (移植组 ) 43例 ,并与同期未行胎胰移植的肾移植手术患者 76例 (对照组 )进行比较。结果　移植组 43例中有 2 7例术后胰岛素用量减少 >5 0 % ,持续 3个月以上 (62 .8% ) ,其中有 4例持续已达 2年 ,1例完全停用胰岛素 ;术后 2周内血清胰岛素水平升高 >10 0U /ml的 3 6例 (83 .7% ) ;术后血清C肽升高 >0 .5ng/ml的共 3 4例 (79.1% )。移植组术后生存率及完全恢复工作能力的比率均明显高于对照组。结论　对行肾移植术的I型糖尿病肾病患者 ,肾移植术前先行胎胰移植可提高I型糖尿病性肾功能衰竭患者肾移植术后的疗效     

自体富血小板血浆对自体脂肪颗粒组织移植存活率影响的研究

目的探讨混合注射富血小板血浆最佳浓度,并通过临床混合注射自体富血小板血浆及自体移植脂肪组织,观察自体富血小板血浆对移植脂肪颗粒组织存活率的影响。方法提取抽脂术中获取的脂肪颗粒组织中的脂肪来源干细胞,实验分为4组：A组（对照组）加入10％胎牛血清,B组添加5％富血小板血浆,C组添加10％富血小板血浆,D组添加15％富血小板血浆,传代培养,定时获取细胞行MTT实验,测试细胞生长曲线,并观察细胞形态变化。临床实验选取15例患者,抽取腹部脂肪组织颗粒后进行纯化;同时抽取静脉血,采用离心法提取自体富血小板血浆。纯化的脂肪颗粒与自体富血小板血浆按照10：1的质量比进行混合注射移植。术前、术后1周及术后3个月,患者在B超下行皮下组织厚度测定。结果第3代脂肪来源干细胞培养观察显示,C组有较好的细胞增殖性及活力;临床研究皮下组织厚度增加率为（158．4±83．1）％;术后3个月,皮下组织厚度增加率为（106．4±70．7）％。结论10％富血小板血浆混合浓度对细胞增殖较为适宜,且临床应用可以有效提高自体脂肪颗粒组织移植的存活率,移植后远期仍能达到较为满意的效果,可在临床上进一步推广应用。     

肾移植术后供者特异性抗体对移植肾近期效果的影响

目的 评价肾移植术后供者特异性抗体(Ds-Ab)对移植肾近期效果的影响。方法 对2001年1月至2002年7月间进行尸肾移植的92例受者，使用酶联免疫吸附(ELISA)法，检测受者血清中HLA抗体水平，随访1年。结果 16例(17．4％)受者术后出现供者特异性抗体。抗体阳性组急性排斥发生率(56．3％)高于抗体阴性组(11．9％)，P=0．000；移植肾功能延迟恢复的发生率(12．5％)与抗体阴性组(9．2％)比较，差异无显著性，P=0．102；供者特异性抗体阳性组受者发生急性排斥后，移植肾肌酐水平高于抗体阴性组或无急性排斥组。结论 供者特异性抗体与肾移植术后急性排斥有关，可能影响近期移植肾功能。     

多囊肾患者肾移植的临床研究

目的　分析多囊肾病 (PKD)患者肾移植术后移植效果 ,并探讨影响因素。方法　选取19 78年至 2 0 0 2年 46例PKD肾移植患者 (PKD组 )和 46例其它肾脏病 (非糖尿病肾病 )肾移植患者(对照组 )进行回顾性分析。评估人、肾存活率 (肾移植后 1、3和 5年 ) ,以及术后并发症 ,如感染和心血管疾病等情况。结果　两组患者 1、3、5年人存活率 :PKD组为 95.7%、91.3 %、91.3 % ;对照组为97.8%、95.7%、93 .5% ;肾存活率 :PKD组为 93 .5%、89.1%、87.0 % ;对照组为 95.7%、89.1%、87.0 %。PKD组中 ,女性患者 5年移植人、肾存活率达到 10 0 %、10 0 % ,男性只有 88.2 %、82 .4% ,差异有显著性 (P <0 .0 5)。PKD组患者比对照组更易发生尿路感染 (P <0 .0 5) ;其它部位的感染发生率相似。两组心血管并发症差异无显著性 (PKD组 3例 ,对照组 4例 )。结论　PKD组和对照组总的人、肾存活率差异无显著性。PKD组的女性患者肾移植后存活率高于男性 ,可能与性激素的影响有关。尿路感染和严重的肺部感染可能是PKD患者术后主要的并发症。     

单中心扩展标准的公民逝世后器官捐献肾移植的近期效果观察

目的分析扩展标准的公民逝世后器官捐献(ECD)肾移植病人的近期效果。方法ECD肾移植50例,标准的公民逝世后器官捐献(SCD)肾移植140例,比较两组移植肾病人早期恢复情况、术后1年内移植肾功能变化、受者和移植肾存活情况以及排斥反应、感染和手术并发症发生率。结果 ECD肾移植组病人术后1年的受者和移植肾存活率、总体感染发生率、急性排斥反应发生率与同期SCD组病人比较,差异均无统计学意义(P0.05)。但ECD组病人在肾移植术后第1、3、6、12个月血肌酐水平高于SCD组,ECD组肾小球滤过率(eGFR)SCD组,差异有统计学意义(P0.05)。结论现行ECD纳入标准下ECD肾移植术后近期效果良好,虽然在移植肾功能(血肌酐水平和eGFR)方面差于SCD肾移植,但在合理选择受者的前提下ECD可作为扩大供体来源的重要途径,其远期效果仍需进步观察。     

合并顽固性高血压的尿毒症患者肾移植前切除双肾对移植肾功能的影响

目的　探讨尿毒症合并药物难以控制的高血压患者肾移植前切除双肾对术后血压及移植肾功能的影响。方法　 42例合并顽固性高血压的尿毒症患者分成 2组 (每组 2 1例 ) ,一组先行双肾切除 ,6个月～ 1年后再行肾移植 ,另一组不切肾 ,直接施行肾移植。对比分析 2个组肾移植术后的血压及移植肾功能的恢复情况。结果　切肾组在双肾切除后 ,13例 (6 1.9% )的平均舒张压低于 90mmHg或较术前降低 10mmHg以上 ;6例 (2 8.6 % )的平均舒张压较术前降低 15 %以上 ;肾移植术后1年 ,双肾切除组血压正常者 11例 (5 2 .4% ) ,对照组血压正常者 5例 (2 3.8% ) ,两组比较 ,差异有显著性 (P <0 .0 5 ) ;移植肾 1年存活率 ,切肾组为 95 .2 % ,对照组为 81.0 % ,差异有显著性 (P <0 .0 1)。结论　存在顽固性高血压的尿毒症患者若需行肾移植 ,在明确手术指征的情况下可先行自体双肾切除术 ,这有利于肾移植术后血压的控制及移植肾功能的稳定     

糖尿病患者血浆瘦素与尿白蛋白排泄率相关性的研究

目的：对2型糖尿病病人的血浆瘦素进行测定，并探讨血浆瘦素与糖尿病肾病的关系。方法：收集我院2001年1月1日-2003年4月内分泌科住院的2型糖尿病患者65例，将其分为临床糖尿病肾病组18例，早期糖尿病肾病组25例，无糖尿病肾病组22例，另设健康对照者30例。采用放射免疫法测定血浆瘦素水平与尿白蛋白排泄率。结果：临床糖尿病肾病组、早期糖尿病肾病组、无糖尿病肾病组及对照组血浆瘦素分别为17．41±5．81、13．32±6．78、9．52±4．34、5．1±3．4。临床糖尿病肾病组、早期糖尿病肾病组、无糖尿病肾病组分别与对照组比较均有统计学差异（P〈0．01）；临床糖尿病肾病组、早期糖尿病肾病纽分别与无糖尿病肾病组比较均有统计学差异（P〈0．01）；临床糖尿病肾病组与早期糖尿病肾病组比较有统计学差异（P〈0．01）；同时各糖尿病组血浆瘦素与尿白蛋白排泄率呈正相关。血浆瘦素水平与年龄、空腹血糖、餐后2h血糖、糖化血红蛋白、胆固醇、三酰甘油等无相关关系。结论：血浆瘦素参与2型糖尿病肾病致病的过程，并且是2型糖尿病肾病发病的一种独立危险因子。     

Predictors and Outcomes of Health‐Related Quality of Life in Caregivers of Cardiothoracic Transplant Recipients

Cardiothoracic transplant programs generally require that transplant recipients have family caregivers to assist them posttransplant. The burden of caregiving on the family members remains poorly understood. If caregivers’ well‐being is compromised by caregiving, it may bode poorly for transplant recipients’ own health in the long‐term posttransplant. We examined caregiver health‐related quality of life (HRQOL) during the first year after their family member's transplant, its predictors and its relationship to subsequent patient survival. Adult (aged 18+) caregivers of 242 cardiothoracic transplant recipients (lung = 134; heart = 108) completed assessments of demographics, psychosocial characteristics and caregiver burden at 2 months posttransplant, and HRQOL at 2, 7 and 12 months posttransplant. Recipients’ survival time was obtained from medical records. Caregiver HRQOL was generally high across the first‐year posttransplant in emotional and social functioning; caregiver physical functioning significantly worsened. There were no differences by type of recipient transplant. Greater caregiver burden predicted poorer caregiver HRQOL in several physical domains at 12 months posttransplant. Transplant recipients whose caregivers had lower perceived general health at 12 months posttransplant showed poorer survival rates during the subsequent 7 years of follow up. Transplant teams should identify those caregivers at risk for poorer general health posttransplant to maximize positive outcomes for the entire family.     

Combined kidney and pancreas transplantation. A 3-year experience.

Between May 1988 and September 1991, we performed 26 simultaneous kidney and pancreas transplants and one pancreas transplant after a kidney transplant. All transplants consisted of bladder drainage via a duodenal segment. Actuarial patient, kidney, and pancreas graft survival rates at 12 months were 96%, 88%, and 85%, respectively, and at 24 months were 96%, 88%, and 81%, respectively, and were not significantly different from those of diabetic recipients of cadaver kidney transplants alone. Excellent long-term glycemic control was obtained as monitored by fasting blood glucose and glycosylated hemoglobin levels and by oral glucose tolerance tests. The mean period of hospitalization and number of hospital admissions in the first year posttransplant were significantly greater for patients who received combined kidney and pancreas transplants than for those who received cadaver kidney transplants alone. Combined kidney and pancreas transplants can be performed with patient and graft survival comparable to those of kidney transplants alone, with excellent long-term glycemic control, but result in increased morbidity in the first postoperative year.     

Bisphosphonates and bone fractures in long-term kidney transplant recipients

BACKGROUND: There is little information on the role of bisphosphonates and bone mineral density (BMD) measurements for the follow-up and management of bone loss and fractures in long-term kidney transplant recipients. METHODS: To address this question, we retrospectively studied 554 patients who had two BMD measurements after the first year posttransplant and compared outcomes in patients treated, or not with bisphosphonates between the two BMD assessments. Kaplan-Meier survival and stepwise Cox regression analyses were performed to examine fracture-free survival rates and the risk-factors associated with fractures. RESULTS: The average time (+/-SE) between transplant and the first BMD was 1.2+/-0.05 years. The time interval between the two BMD measurements was 2.5+/-0.05 years. There were 239 and 315 patients in the no-bisphosphonate and bisphosphonate groups, respectively. Treatment was associated with significant preservation of bone loss at the femoral neck (HR 1.56, 95% CI 1.21-2.06, P=0.0007). However, there was no association between bone loss at the femoral neck and fractures regardless of bisphosphonate therapy. Stepwise Cox regression analyses showed that type-1 diabetes, baseline femoral neck T-score, interleukin-2 receptor blockade, and proteinuria (HR 2.02, 0.69, 0.4, 1.23 respectively, P<0.01), but not bisphosphonates, were associated with the risk of fracture. CONCLUSIONS: Bisphosphonates may prevent bone loss in long-term kidney transplant recipients. However, these data suggest a limited role for the initiation of therapy after the first posttransplant year to prevent fractures.     

2202 Kidney Transplant Recipients with 10 Years of Graft Function: What Happens Next?

The ultimate goal of clinical transplantation is for the recipients to achieve long‐term survival, with continuing graft function, that is equivalent to that of the age‐matched general population. We studied subsequent outcome in kidney transplant recipients with 10 years of graft function. In all, 2202 kidney transplant recipients survived with graft function >10 years. For 10‐year survivors, the actuarial 25‐year patient survival rate for primary transplant living donor (LD) recipients was 57%; graft survival, 43%. For primary transplant deceased donor (DD) recipients, the actuarial 25‐year patient survival rate was 39%; graft survival, 27%. The two major causes of late graft loss were death (with graft function) and chronic allograft nephropathy (tubular atrophy and interstitial fibrosis). The two major causes of death with function were cardiovascular disease (CVD) and malignancy. For nondiabetic recipients, the mean age at death with function from CVD was 54 ± 13 years; for diabetic recipients, 53 ± 7 years. By 20 years posttransplant, morbidity was common: >40% recipients had skin cancer (mean age for nondiabetic recipients, 53 ± 13 years; for diabetics, 49 ± 8 years), >10% had non‐skin cancer (mean age for nondiabetic recipients, 53 ± 16 years; for diabetics, 46 ± 9 years), and >30% had CVD (mean age for nondiabetic recipients, 53 ± 15 years; for diabetics, 47 ± 9 years). We conclude that long‐term transplant recipients have a high rate of morbidity and early mortality. As short‐term results have improved, more focus is needed on long‐term outcome.     

Short‐term kidney transplant outcomes among African American recipients do not predict long‐term outcomes: donor pair analysis

Keith D, Patrie JT. Short‐term kidney transplant outcomes among African‐American recipients do not predict long‐term outcomes: donor pair analysis.
Clin Transplant 2011: 25: 69–76. © 2010 John Wiley & Sons A/S. Abstract: African American (AA) renal transplant recipients have poorer graft survival compared to other racial and ethic groups. This study was undertaken to determine whether pre‐transplant factors and events occurring in the first six months post‐transplant were predictive of the poorer long‐term outcomes in AA recipients. To control for kidney quality, a paired analysis of deceased donor kidneys in which one donor kidney was transplanted into an adult AA recipient and the other was transplanted into an adult Caucasian was undertaken. Cox proportional hazard modeling was used to determine the impact of outcome variables at six months. Outcomes at six months among the paired recipients were very similar for graft and patient survival, and estimated glomerular filtration rate (GFR). Less than 10% of difference in long‐term outcomes was explained by differences in the pre‐transplant covariates and events in the first six months. Causes of graft failure after six months revealed a two to three times higher rate of chronic allograft nephropathy (CAN) and late acute rejection among AA. In conclusion, early outcomes after kidney transplant did not predict the poor long‐term graft survival among AA, and AA recipients appear to be more prone to graft loss because of CAN and late acute rejection.     

Economic Impacts of ABO‐Incompatible Live Donor Kidney Transplantation: A National Study of Medicare‐Insured Recipients

The infrequent use of ABO‐incompatible (ABOi) kidney transplantation in the United States may reflect concern about the costs of necessary preconditioning and posttransplant care. Medicare data for 26 500 live donor kidney transplant recipients (2000 to March 2011), including 271 ABOi and 62 A2‐incompatible (A2i) recipients, were analyzed to assess the impact of pretransplant, transplant episode and 3‐year posttransplant costs. The marginal costs of ABOi and A2i versus ABO‐compatible (ABOc) transplants were quantified by multivariate linear regression including adjustment for recipient, donor and transplant factors. Compared with ABOc transplantation, patient survival (93.2% vs. 88.15%, p = 0.0009) and death‐censored graft survival (85.4% vs. 76.1%, p < 0.05) at 3 years were lower after ABOi transplant. The average overall cost of the transplant episode was significantly higher for ABOi ($65 080) compared with A2i ($36 752) and ABOc ($32 039) transplantation (p < 0.001), excluding organ acquisition. ABOi transplant was associated with high adjusted posttransplant spending (marginal costs compared to ABOc ‐ year 1: $25 044; year 2: $10 496; year 3: $7307; p < 0.01). ABOi transplantation provides a clinically effective method to expand access to transplantation. Although more expensive, the modest increases in total spending are easily justified by avoiding long‐term dialysis and its associated morbidity and cost.     

OPTN/SRTR 2018 Annual Data Report: Hepatitis C

Direct acting antivirals (DAAs) have fundamentally changed the treatment of hepatitis C virus (HCV) infection and reduced the discard rate of HCV‐infected organs by offering a treatment option with a high likelihood of cure posttransplant. This has spurred increased interest in transplanting organs from HCV‐positive donors into recipients both with and without HCV. In this chapter, we examine data from 2007 to 2018 to determine trends in HCV (+) donor transplants across various organ types. Since 2015, willingness to accept HCV (+) organs increased for candidates waitlisted for kidney, lung, heart, and pancreas transplant, but decreased for those listed for intestine transplant. For candidates listed for liver transplant, willingness to accept HCV (+) organs decreased from 2007 to 2017, but began increasing in 2017. Willingness to accept was not concentrated in a single US geographic area, and there was substantial variation among transplant programs and donation service areas. Numbers of anti‐HCV (+) donor kidney, heart, lung, and liver transplants have increased considerably in the past few years. Short‐term allograft survival for kidney and liver transplant recipients of anti‐HCV (+) organs appears to be comparable to that for recipients of anti‐HCV (‐) organs in an unadjusted analysis. However, an unadjusted analysis indicates that long‐term allograft survival may be worse. Kidney transplant between HCV‐infected donors and uninfected recipients with posttransplant DAA treatment is an emerging area. Short‐term data are promising, with similar 1‐year allograft survival compared with HCV‐uninfected donor to HCV‐uninfected recipient kidney transplants in unadjusted analyses. However, long‐term data are lacking and close monitoring in the future is warranted.     

OPTN/SRTR 2018 Annual Data Report: Heart

The new adult heart allocation policy was approved in 2016 and implemented in October 2018, so its effect was not yet evident in 2018 data. However, the more granular data being collected are anticipated to allow for improved analyses. In 2018, new listings continued to increase; 3883 new adult and 685 new pediatric candidates were added. In 2018, 3440 heart transplants were performed, an increase of 167 over 2017; 473 transplants occurred in pediatric recipients and 2967 in adult recipients. Short‐term and long‐term posttransplant mortality improved. Overall 1‐year survival for adults who underwent heart transplant in 2011‐2013 was 90.3%, 3‐year survival was 84.7%, and 5‐year survival was 79.6%. Mortality rates for pediatric recipients were 4.5% at 6 months and in 5.9% at 1 year posttransplant, 12.5% at 3 years for transplants in 2014‐2015, 14.8% at 5 years for transplants in 2012‐2013, and 29.8% at 10 years for transplants performed in 2008‐2009.     

Pancreas after kidney transplants

BACKGROUND: For certain uremic diabetic patients, a sequential transplant of a kidney (usually from a living donor) followed by a cadaver pancreas has become an attractive alternative to a simultaneous transplant of both organs. The purpose of this study was to compare outcomes with simultaneous pancreas-kidney (SPK) versus pancreas after kidney (PAK) transplants to determine advantages and disadvantages of the two procedures. METHODS: Between January 1, 1994, and June 30, 2000, we performed 398 cadaver pancreas transplants at our center. Of these, 193 were SPK transplants and 205 were PAK transplants. We compared these two groups with regard to several endpoints, including patient and graft survival rates, surgical complications, acute rejection rates, waiting times, length of hospital stay, and quality of life. RESULTS: Overall, surgical complications were more common for SPK recipients. The total relaparotomy rate was 25.9% for SPK recipients versus 15.1% for PAK recipients (P = 0.006). Leaks, intraabdominal infections, and wound infections were all significantly more common in SPK recipients (P = 0.009, P = 0.05, and P = 0.01, respectively, versus PAK recipients). Short-term pancreas graft survival rates were similar between the two groups: at 1 year posttransplant, 78.0% for SPK recipients and 77.9% for PAK recipients (P = not significant). By 3 years, however, pancreas graft survival differed between the two groups (74.1% for SPK and 61.7% for PAK recipients), although this did not quite reach statistical significance (P = 0.15). This difference in graft survival seemed to be due to increased immunologic losses for PAK recipients: at 3 years posttransplant, the incidence of immunologic graft loss was 16.2% for PAK versus 5.2% for SPK recipients (P = 0.01). Kidney graft survival rates were, however, better for PAK recipients. At 3 years after their kidney transplant, kidney graft survival rates were 83.6% for SPK and 94.6% for PAK recipients (P = 0.001). The mean waiting time to receive the pancreas transplant was 244 days for SPK and 167 days for PAK recipients (P = 0.001). CONCLUSIONS: PAK transplants are a viable option for uremic diabetics. While long-term pancreas graft results are slightly inferior to SPK transplants, the advantages of PAK transplants include the possibility of a preemptive living donor kidney transplant, better long-term kidney graft survival, significantly decreased waiting times, and decreased surgical complication rates. Use of a living donor for the kidney transplant expands the donor pool. Improvements in immunosuppressive regimens will hopefully eliminate some of the difference in long-term pancreas graft survival between SPK and PAK transplants.