Study Raises Questions About Dual Pancreas-Kidney Transplants

A study published in the December 1995 issue of Lancet, indicating a dual pancreas-kidney transplant may be more dangerous than previously suspected, has stirred controversy at the University of Minnesota.

The study, which was performed by C.L. Manske at the University of Minnesota School of Medicine, compared 54 diabetic patients who received both a kidney and pancreas transplant to 46 diabetic patients who received only a kidney transplant.

Patients who received both organs had a 32 percent higher rate of mortality. In addition, 15 patients who received both organs suffered infections and needed a pancreatectomy (removal of the pancreas). The study said two other variables associated with incidence of mortality were age and history of congestive heart failure.

David Sutherland, a professor of surgery at the school and one of the leading proponents of dual pancreas-kidney transplants, said the study is “seriously flawed.”

The retrospective study was limited to patients with coronary disease or the need of cardiac evaluations, said Sutherland, thus excluding over a third of the dual transplants performed during the time period of the study.

Sutherland cited studies from the January 1993 Transplant Proceedings, and the book “Clinical Transplants,” which indicate the mortality rate for kidney-pancreas transplants is actually less than from kidney transplants alone in people with diabetes.

The Manske study recommended re-examining the practice of performing a pancreas transplant on already immunosuppressed kidney transplant patients. The researchers felt the combined transplant should only be performed in young patients with no history of congestive heart failure, or when high blood sugars are life-threatening.

Sutherland agreed that older cardiac patients are at a higher risk of mortality from such transplants but said for other patients “the risk can be taken to improve quality of life . . . the risk is not high, if it exists at all.”

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