O6
Simultaneous Pancreas and Kidney Transplantation: Twelve years of a National
Service.
Samantha Hayward1, Christine Jansen1, Andrew Sutherland1, Jamie Traynor2, Gabriel
Oniscu1, Wendy Metcalfe1,2.
¹Royal Infirmary of Edinburgh, ²Scottish renal Registry.
Introduction
Since 2002 all simultaneous pancreas and kidney (SPK) transplantation in Scotland has been
nationally commissioned to be performed in our centre. We aimed to evaluate the service in
terms of activity and outcomes of all patients referred for consideration of SPK in the twelve
years 2002-2013.
Methods
A prospective data base of all patients referred to the Scottish national pancreas transplant
service has been maintained since the service was commissioned to commence in 2002.
Patients referred for pancreas after kidney, pancreas alone or islet cell transplantation are
excluded from these analyses.
The outcomes of patients referred for assessment of SPK who had been treated by any
modality of renal replacement therapy (RRT) were determined from the Scottish Renal
Registry (SRR). Outcomes of patients not treated with RRT were determined where possible
from the electronic patient record held within the transplant centre. Follow-up data were
collected until 31 December 2014.
Results
In the twelve years 2002-2013 377 individuals were referred for assessment for consideration
of 379 potential SPK procedures. 339 (89.4%) of assessments were for Scottish residents, the
remainder were for patients resident in Northern Ireland, these patients are excluded from
further analyses.
199 (58.7%) assessments resulting in listing for SPK, 75 (22.1%) in listing for kidney
transplantation alone, 61 (18%) patients were not listed for either procedure and 4 patients
were still being assessed/ worked up for transplant listing at the end of the follow-up period.
In 6 instances the decision to list for kidney transplantation alone was due to patient
preference following engagement in the SPK assessment process, in the remainder the
decision was made on clinical grounds.
Patients listed for SPK were younger than those listed for kidney alone, mean age 39.4 years
SD 8 vs mean 44.4 years SD 8.5 (p<0.001). 101 (51%) of the group listed for SPK were male
compared with 45 (60%) of the group listed for kidney alone.
73 (37%) patients were listed for SPK pre-emptively, that is before starting any type of RRT
[Range -721 – 5966 days; Median 166 IQR -61 – 377]. In contrast on 14 (19%) of those
referred for SPK but listed for kidney alone were listed pre-emptively [Range -598 – 7867
days; Median 216 IQR 33 – 503].
Within the follow-up period to 31 December 2014 (minimum 1 years) 161 (81.9%) of those
listed for SPK had received an SPK transplant.
Of those receiving SPK transplant: 5 patients died within 45 days of their transplant. 24 had a
pancreatectomy of which 19 occurred within the first month (median 15 days IQR 6-30).119
had a pancreas still working at the end of the follow-up period. One year patient survival was
97 %; one year kidney transplant survival was 96%.
In the same time period 30 (40%) of those listed for kidney alone received a kidney
transplant. One year patient survival was 100%.
Conclusions
In an analysis of twelve years of referrals for assessment for SPK transplantation in Scotland
under 60% of patients referred for SPK were listed for that procedure, but once listed the
majority of patients received an SPK transplant in the follow-up period.