Mori Tomomi, Nyumura Izumi, Hanai Ko, Shinozaki Tomohiro, Babazono Tetsuya
Division of Diabetology and Metabolism, Department of Internal Medicine, Tokyo Women's Medical University School of Medicine, 8-1 Kawada-Cho, Shinjuku-Ku, Tokyo, 162-8666 Japan.
Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan.
Diabetol Int. 2024 Jan 24;15(2):278-289. doi: 10.1007/s13340-024-00691-z. eCollection 2024 Apr.
This single-center observational cohort study aimed to assess the potential benefits of simultaneous pancreas and kidney transplantation (SPK) in terms of mortality and kidney graft outcomes in Japanese individuals with type 1 diabetes (T1D) and end-stage kidney disease (ESKD). We first compared all-cause mortality rates between 78 SPK recipients and 108 non-transplanted individuals with T1D and ESKD. To mitigate the bias stemming from immortal time before receiving SPK, we utilized Cox regression models treating SPK as a time-dependent covariate. Next, we compared all-cause mortality rates and kidney graft loss rates between 65 SPK recipients and 58 kidney transplantation alone (KTA) recipients. Multivariate Cox hazard models and Fine and Gray competing-risk models were employed. SPK recipients experienced significantly lower all-cause mortality rates than non-transplanted individuals, even after accounting for immortal time bias ( = 0.015 by log-rank test, hazard ratio [HR] = 0.334, = 0.025). When comparing SPK and KTA recipients, no statistically significant difference was observed in mortality rates (HR = 0.627, = 0.588 by Cox model; HR = 0.385, = 0.412 by Fine and Gray model) or kidney graft loss rates (HR = 0.612, = 0.436 by Cox model; HR = 0.639, = 0.376 by Fine and Gray model). Dysglycemia-associated mortality were observed in non-transplanted individuals and KTA recipients, but not in SPK recipients. These findings highlight the potential life-saving impact of SPK compared with intensive insulin therapy and dialysis. Additionally, this study suggests that both SPK and KTA may offer comparable outcomes. These findings have significant implications for clinical decision-making in the context of organ transplantation for individuals with T1D and ESKD
这项单中心观察性队列研究旨在评估在日本1型糖尿病（T1D）和终末期肾病（ESKD）患者中，同时进行胰腺和肾脏移植（SPK）在死亡率和肾移植结局方面的潜在益处。我们首先比较了78例SPK受者与108例未接受移植的T1D和ESKD患者的全因死亡率。为了减轻接受SPK之前的不朽时间所导致的偏差，我们使用Cox回归模型将SPK作为时间依赖性协变量。接下来，我们比较了65例SPK受者与58例单纯肾移植（KTA）受者的全因死亡率和肾移植丢失率。采用了多变量Cox风险模型和Fine and Gray竞争风险模型。即使在考虑不朽时间偏差后，SPK受者的全因死亡率仍显著低于未接受移植的个体（对数秩检验P = 0.015，风险比[HR] = 0.334，P = 0.025）。在比较SPK和KTA受者时，死亡率（Cox模型HR = 0.627，P = 0.588；Fine and Gray模型HR = 0.385，P = 0.412）或肾移植丢失率（Cox模型HR = 0.612，P = 0.436；Fine and Gray模型HR = 0.639，P = 0.376）均未观察到统计学上的显著差异。在未接受移植的个体和KTA受者中观察到了与血糖异常相关的死亡率，但在SPK受者中未观察到。这些发现突出了与强化胰岛素治疗和透析相比，SPK潜在的挽救生命的影响。此外，本研究表明SPK和KTA可能提供相当的结局。这些发现对于T1D和ESKD患者器官移植背景下的临床决策具有重要意义。
