LAUSR

Following simultaneous pancreas-kidney transplantation (SPKT), survival outcomes are reported as equivalent in patients with detectable pretransplant C-peptide levels (Cp+) and a "type 2" diabetes mellitus (DM) phenotype compared to type 1 (Cp negative [Cp-]) DM. We retrospectively compared 46 Cp+ patients pretransplant (≥2.0 ng/ml, mean 5.4 ng/ml) to 46 Cp- (level <0.5 ng/ml) case controls matched for recipient age, gender, race, and transplant date. Early outcomes were comparable. Actual 5-year patient survival (91% versus 94%), kidney graft survival (69% versus 86%, p = 0.15), and pancreas graft survival (60% versus 86%, p = 0.03) rates were lower in Cp+ versus Cp- patients, respectively. The Cp+ group had more pancreas graft failures due to insulin resistance (13% Cp+ versus 0% Cp-, p = 0.026) or rejection (17% Cp+ versus 6.5% Cp-, p = 0.2). Post-transplant weight gain >5 kg occurred in 72% of Cp+ versus 26% of Cp- patients (p = 0.0001). In patients with functioning grafts, mean one-year post-transplant HbA1c levels (5.0 Cp+ versus 5.2% Cp-) were comparable whereas Cp levels were higher in Cp+ patients (5.0 Cp+ versus 2.6 ng/ml Cp-). In this matched case-control study, outcomes were inferior in Cp+ compared to Cp- patients following SPKT, with post-transplant weight gain, insulin resistance, and rejection as potential mitigating factors. This article is protected by copyright. All rights reserved.