Relative survival and quality of life benefits of pancreas–kidney transplantation, deceased kidney transplantation and dialysis in type 1 diabetes mellitus—a probabilistic simulation model

Rashmi Shingde, Vaishnavi Calisa, Jonathan C. Craig, Jeremy R. Chapman, Angela C. Webster, Henry Pleass, Philip J. O’Connell, Richard Allen, Paul Robertson, Lawrence Yuen, Kathy Kable, Brian Nankivell, Natasha M. Rogers, Germaine Wong

Research output: Contribution to journalArticle

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Abstract

For patients with type 1 diabetes mellitus who progress to the point of requiring renal replacement therapy, the relative benefits of simultaneous pancreas and kidney transplantation (SPK) and deceased donor kidney transplantation across different age categories compared to dialysis are uncertain. Using Australian and New Zealand registry data from 2006 to 2016, a probabilistic Markov model (n = 10 000) was built comparing patient survival between SPK and deceased donor kidney transplantation with dialysis. Compared to dialysis, the average life years saved (LYS) and quality-adjusted life years (QALY) for SPK and deceased donor kidney transplantation were 5.48 [95% CI 5.47, 5.49] LYS and 6.48 [6.47, 6.49] QALY, and 3.38 [3.36, 3.40] LYS and 2.46 [2.45, 2.47] QALY, respectively. For recipients aged 50 years or younger, receiving a deceased donor kidney, the average incremental gains compared to dialysis were 4.13 [4.10, 4.16] LYS and 2.99 [2.97, 3.01] QALY, and for recipients older than 50 years, 3.05 [3.02, 3.08] LYS and 2.25 [2.23, 2.27] QALY. Compared to dialysis, SPK transplantation incurs the greatest benefits in LYS and QALY for patients with type 1 diabetes requiring renal replacement therapy. Patients older than 50 years still experience survival benefits from deceased donor kidney transplantation compared to dialysis.

Original languageEnglish
Number of pages12
JournalTRANSPLANT INTERNATIONAL
Early online date23 Jun 2020
DOIs
Publication statusE-pub ahead of print - 23 Jun 2020

Keywords

  • kidney transplantation
  • quality of life
  • SPK survival
  • type 1 diabetes

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