Background. The aim of this study was to assess whether kidney-pancreas transplantation (KPT) compromises the prognosis of kidney transplantation Methods. This study included 368 paired recipients who received grafts from the same donor (184 KPT/184 KT), i.e., renal grafts with the same pretransplant functional and pathologic characteristics. Results. KPT recipients (KPR) were significantly younger and included fewer African- Americans (22% vs. 6%, P=0.0002) than recipients of kidney alone (KR). During year 1 after transplant surgery, KPR were readmitted more often than KR (4.2±2 vs. 2.8±2, P<0.0001). The number of acute rejections (AR) and the serum creatinine were not significantly different in KR and KPR up to 3 years aft transplant. After 44±29 months, 13% of KS and 17% of KPR died (NS), and 17% of KR and 16% of KPR lost their kidneys (NS). In KPR, reduced renal graft survival did not correlate with AR (P=0.44), but it correlated with: older donors, younger recipients, elevated serum creatinine at 6 months, pancreas loss, and the number of episodes of acute graft dysfunction evaluated by biopsy (multivariate analysis). By Cox, graft and patient survival were not significantly different in KR and KPR. However, the patient survival of KPR <40 years of age was lower than that of KR (P=0.02). Renal biopsies (n=165) in 40 younger recipients showed no significantly differences in AR, interstitial fibrosis, or vascular pathology. Conclusions. Renal graft function, structure, and survival are not different in KPR and KR, but the correlates of renal graft survival are different in these two groups of recipients.
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