ArticleTransplantation direct2026
The Time-varying Impact of Pancreas Graft Failure on Mortality and Kidney Graft Outcomes in Simultaneous Pancreas and Kidney Transplantation.
Article in Transplantation direct, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Authors and funding
4 authors.
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Abstract
Background: Simultaneous pancreas-kidney transplantation improves survival and glycemic control in insulin-dependent diabetes, but pancreas graft failure remains common, and its evolving impact on patient survival and downstream kidney outcomes is inadequately defined. Methods: Using 2013-2022 US Scientific Registry of Transplant Recipients data, we treated pancreas death-censored graft failure (DCGF) as a time-dependent exposure in Cox models for mortality, and kidney all-cause graft failure and DCGF. Early (≤1 y) and landmark (>1 y) analyses addressed nonproportional hazards. Sensitivity analyses conducted on post-March 2018 standardized failure definitions and technical failures. Subgroup analyses analyzed age, sex, and diabetes type. In a 1-y landmark subcohort with intact grafts, we analyzed associations between subsequent kidney DCGF and 5-y mortality. Results: Pancreas DCGF occurred in 1013 recipients (5-y incidence 13.7%), predominantly within 1 y (33% technical), conferring increased mortality early (hazard ratio [HR] 2.97; 95% confidence interval [CI], 2.04-4.34) and sustained risk beyond 1 y (HR 2.47; 95% CI, 1.87-3.25), with similar findings post-2018. Technical DCGF carried modest risk (HR 1.56; 95% CI, 1.16-2.09). Pancreas DCGF was also associated with kidney all-cause graft failure (HR 2.33; 95% CI 2.01, 2.69) and DCGF (HR 2.70; 95% CI, 2.25-3.25). In those with intact grafts at 1 y, kidney DCGF conferred markedly higher 5-y mortality (HR 9.37; 95% CI, 7.04-12.48). Younger recipients exhibited slightly greater relative mortality risk after pancreas DCGF (ratio of HR 1.10). Conclusions: Pancreas DCGF is common and independently heralds substantially increased risks of death and kidney graft loss, whereas kidney failure further amplifies mortality, underscoring the need for enhanced risk stratification, prevention, and post-failure management to optimize long-term simultaneous pancreas-kidney outcomes. Younger recipients also faced a higher relative mortality risk after pancreas failure, highlighting a vulnerable subgroup requiring further study.
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