Impact of Abdominal Aortic Calcification on Pancreas Graft Survival in Patients Undergoing Simultaneous pancreas-kidney Transplantation.

Abstract

Background: Pancreas transplantation (PTx) is definitive therapy for patients with type 1 diabetes and advanced chronic kidney disease. Abdominal aortic calcification (AAC) is often observed in patients waiting for PTx and progresses according to the waiting period, but the impact of AAC on long-term outcomes remains unclear. In this study, we aimed to elucidate the impact of AAC on long-term outcomes.

Methods: We reviewed 65 consecutive PTx cases at our institution between April 2000 and November 2022 and enrolled 50 patients with simultaneous pancreas-kidney transplantation (SPK). AAC was assessed as AAC score by the Agatston method using multi-detector computed tomography.

Results: Receiver operating characteristic curves were used to determine the cut-off value of the AAC score for death-uncensored pancreas graft survival; the area under the curve was 0.711 (P=0.029). After dividing the patients into two groups according to the AAC cut-off, the dialysis period was significantly longer in the high AAC score group than in the low AAC score group (P=0.001). Death-uncensored pancreas graft survival and patient survival after SPK were significantly lower in the high AAC score group than in the low AAC score group (P=0.001, 0.001, respectively). In a Cox proportional hazards regression model, high AAC score was independently associated with death-uncensored pancreas graft loss (P=0.002).

Conclusions: AAC is associated with death-uncensored pancreas graft survival in patients undergoing SPK. Evaluation of AAC could be useful for predicting post-PTx prognosis.