Simultaneous pancreas kidney transplantation (SPK) is an increasingly common treatment option for patients with end-stage renal disease due to Type I diabetes (DM). Recent studies suggest SPK may improve kidney allograft survival compared to kidney transplantation alone (KA). However, patient selection may account for this disparity since patient sociodemographics and comorbidities likely impact consideration for SPK. The objectives of this study are to assess the impact of patient selection on access to SPK versus KA and to determine the impact of SPK on renal allograft survival. In order to avoid selection bias, the comparison of renal allograft survival between SPK and KA recipients will be limited to patients waitlisted for SPK: approximately 10 percent of patients listed for SPK receive a KA due a fatty or traumatized pancreas allograft, or availability of a zero-antigen mismatch kidney alone. The USRDS has collected comorbidity data since April 1995. To assess the impact of patient selection on access to SPK we will use these national data to conduct a cross-sectional study of DM patients waitlisted for either SPK or KA after April 1995. We will compare patient socioeconomic demographics, comorbidities, and transplant center characteristics between these two groups. Logistic regression will be used to identify independent determinants of access to SPK. To determine the impact of SPK on renal allograft survival, we will conduct a retrospective cohort study of all patients waitlisted for SPK and transplanted with SPK or KA after April 1995. Renal allograft survival in SPK and KA will be compared using Cox proportional hazards models, adjusting for patient and transplant center characteristics.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Postdoctoral Individual National Research Service Award (F32)
Project #
1F32DK060298-01
Application #
6406173
Study Section
Epidemiology and Disease Control Subcommittee 2 (EDC)
Program Officer
Rankin, Tracy L
Project Start
2002-02-01
Project End
Budget Start
2001-07-01
Budget End
2002-06-30
Support Year
1
Fiscal Year
2001
Total Cost
$70,965
Indirect Cost
Name
University of Pennsylvania
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Israni, Ajay K; Feldman, Harold I; Propert, Kathleen J et al. (2005) Impact of simultaneous kidney-pancreas transplant and timing of transplant on kidney allograft survival. Am J Transplant 5:374-82
Israni, Ajay K; Halpern, Scott D; Zink, Sheldon et al. (2005) Incentive models to increase living kidney donation: encouraging without coercing. Am J Transplant 5:15-20
Halpern, Scott D; Berns, Jeffrey S; Israni, Ajay K (2004) Willingness of patients to switch from conventional to daily hemodialysis: looking before we leap. Am J Med 116:606-12
Israni, Ajay K; Halpern, Scott D; McFadden, Christopher et al. (2004) Willingness of dialysis patients to participate in a randomized controlled trial of daily dialysis. Kidney Int 65:990-8
Israni, A; Krok, K; Cohen, D et al. (2004) Ganciclovir prophylaxis delays but does not prevent cytomegalovirus infection in renal transplant recipients. Transplant Proc 36:3019-24
Berman, Elisheva; Merz, Jon F; Rudnick, Michael et al. (2004) Religiosity in a hemodialysis population and its relationship to satisfaction with medical care, satisfaction with life, and adherence. Am J Kidney Dis 44:488-97
Israni, Ajay; Korzelius, Cynthia; Townsend, Raymond et al. (2003) Management of chronic kidney disease in an academic primary care clinic. Am J Nephrol 23:47-54