Cox regression survival analyses found no significant differences in allograft (pancreas and kidney) and patient survival in the 2 2 groups. follow up, all patients with T2DM had HbA1C 6.0 at 1 year vs. 92% of those with T1DM. Conclusion SPKTx needs to be considered in the therapeutic armamentarium for renal replacement in selected patients with T2DM and ESRD. Utilization of C-peptide in patients with ESRD as sole criteria to phenotype type of diabetes can be misleading. Background Simultaneous pancreas and kidney transplantation (SPKTx) is a well accepted therapeutic option for patients with Type 1 DM (T1DM) and ESRD. However, there is no BNS-22 consensus with respect to performing SPKTX among patients with type 2 diabetes mellitus (T2DM) with end-stage renal disease BNS-22 (ESRD). Nevertheless, approximately 5-10% of all SPK transplants reported to the SRTR are performed in patients with T2DM and ESRD. Prior studies have reported comparable outcomes in Rabbit Polyclonal to SEPT6 improvement in quality of life and allograft and patient survival among patients with T2DM similar to patients withT1DM receiving SPKTx.1-4 Assigning a type of diabetes to an individual with ESRD becomes challenging due to the alteration in the insulin and glucose metabolism in patients with kidney disease, and many diabetics do not strictly fit into one class. Since there are no absolute established diagnostic criteria to assign a type of diabetes, individual centers have used their discretion in adopting criteria in the labeling of a patient as T2DM. Prior reports have included a combination of C-peptide cutoffs C C-peptide 0.8 ng/mL,2 C-peptide 2 ng/mL5 and clinical criteria based on American Diabetes Association and World Health Organization guidelines. However, since the kidney is the major site for C-peptide catabolism and excretion,6-10 the utilization of BNS-22 C-peptide alone to phenotype BNS-22 diabetes in patients with ESRD is imprecise. To improve the discriminating power and better classify type of diabetes in patients with ESRD, we chose a composite criterion including clinical criteria, C-peptide assay and autoimmune response to pancreatic -cell C by measuring antiglutamic acid decarboxylase (anti-GAD 65) antibodies and compared outcomes between T1DM and T2DM after SPKTx. Methods After Institutional Review Board approval, we conducted a retrospective observational study to compare recipient and donor characteristics in addition to allograft (kidney and pancreas) and patient survival after SPK transplant between T2DM vs. T1DM. We used the following composite definition to identify T2DM: Presence of C-peptide, negative GAD65 antibody, absence of diabetic ketoacidosis and use of oral hypoglycemics during the course of disease. Additionally, BMI 30 and use of than 1 unit/kg of insulin/day were also used in selecting T2DM patients for SPKTx. Patients designated as T1DM included those with early onset of disease, requirement of insulin from onset and/or presence of diabetic ketoacidosis. All patients received deceased donor organs and were enteric drained. BNS-22 Immunosuppression included induction with r-ATG (total dose 6 mg/kg) or Campath (30 mg single dose) and maintenance with tacrolimus, mycophenolic acid and rapid steroid taper (off steroids by postoperative day 4). Patients with positive crossmatch received steroid long-term. Functioning kidney allograft was defined as not being retransplanted and not being on dialysis for renal support. Functioning pancreas allograft was defined as normal HbA1c, fasting blood glucose and insulin independence. Results Our study cohort consisted of 80 patients who received SPKTx between October 2003 and September 2008 without immediate technical complications C of whom 10 were assigned as T2DM based on study criteria. Median range of follow-up was 485 days. Table 1 describes our cohort. A T2DM were older and non white. Approximately 87% of T1DM.
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