Pancreas Transplantation in C-Peptide Positive Patients: Does Type of Diabetes Really Matter?: Abstract# B1303

In the recent past, type 2 diabetes was a contraindication for simultaneous pancreas-kidney transplantation (SPKT). Methods: We retrospectively analyzed outcomes in SPKT recipients according to pretransplant C-peptide levels. Results: From 11/01 to 3/13, we performed 162 SPKTs including 132 in patients with absent or low C-peptide levels (<2.0 ng/ml, Group A) and 30 with C-peptide levels ≥2.0 ng/ml (Group B, mean C-peptide level 5.7 ng/ml, range 2.1-12.4). Group B patients had a higher proportion that were age ≥50 years (40% versus 23%, p=0.06), had a later age of onset (mean age 34 Group B versus 16 years Group A, p=0.0001) and shorter duration of pretransplant diabetes (mean 17 Group B versus 25 years Group A, p = 0.01), and had a greater proportion of African Americans (47% Group B versus 17% Group A, p=0.001). With a mean follow-up of 5.5 years, patient survival (85% Group A versus 87% Group B), kidney graft survival (72% Group A versus 77% Group B), and pancreas graft survival (66% Group A versus 57% Group B, all p=NS) rates were comparable. Death-censored kidney (both 85% Group A and B) and pancreas (77% Group A versus 61% Group B) graft survival rates were similar. The incidences of early PT thrombosis (9.8% versus 3%) and early relaparotomy (36% versus 33%) were no different in Groups A and B, respectively. At 5 years follow-up, there were no differences in acute rejection episodes (29% versus 30%), surgical complications, major infections, readmissions, HbA1c and C-peptide levels, or serum creatinine and calculated GFR levels between the 2 groups. Conclusions: Diabetic patients with measurable pretransplant C-peptide levels appear to have a type 2 diabetes phenotype compared to insulinopenic patients undergoing SPKT. However, survival outcomes were similar between groups. Consequently, pretransplant C-peptide levels should not be used exclusively to determine candidacy for SPKT.