Montagud Marrahi, EnriqueCuadrado Payán, ElenaHermida, EvelynCacho, JuditCucchiari, DavidRevuelta, IgnacioDel Risco Zevallos, JimenaEsforzado Armengol, NuriaCofán Pujol, FedericoOppenheimer Salinas, FedericoTorregrosa Prats, José VicenteFerrer Fábrega, JoanaAmor Fernández, AntonioEsmatjes Mompó, EnricRamírez Bajo, María JoséMusquera i Felip, MireiaCooper, MathewBayés Genís, BeatriuCampistol Plana, Josep M.Diekmann, FritzVentura Aguiar, Pedro2023-09-212023-09-212022-05-270085-253835644282https://hdl.handle.net/2445/202160Several organ allocation protocols give priority to wait-listed simultaneous kidney-pancreas (SPK) transplant recipients to mitigate the higher cardiovascular risk of patients with diabetes mellitus on dialysis. The available information regarding the impact of preemptive simultaneous kidney-pancreas transplantation on recipient and graft outcomes is nonetheless controversial. To help resolve this, we explored the influence of preemptive simultaneous kidney-pancreas transplants on patient and graft survival through a retrospective analysis of the OPTN/UNOS database, encompassing 9690 simultaneous transplant recipients between 2000 and 2017. Statistical analysis was performed applying a propensity score analysis to minimize bias. Of these patients, 1796 (19%) were transplanted preemptively. At ten years, recipient survival was significantly superior in the preemptive group when compared to the non-preemptive group (78.9% vs 71.8%). Dialysis at simultaneous kidney-pancreas transplantation was an independent significant risk for patient survival (hazard ratio 1.66 [95% confidence interval 1.32-2.09]), especially if the dialysis duration was 12 months or longer. Preemptive transplantation was also associated with significant superior kidney graft survival compared to those on dialysis (death-censored: 84.3% vs 75.4%, respectively; estimated half-life of 38.57 [38.33 -38.81] vs 22.35 [22.17 - 22.53] years, respectively). No differences were observed between both groups neither for pancreas graft survival nor for post-transplant surgical complications. Thus, our results sustain the relevance of early referral for pancreas transplantation and the importance of pancreas allocation priority in reducing patient mortality after simultaneous kidney-pancreas transplantation.50 p.application/pdfengcc-by-nc-nd (c) International Society of Nephrology, 2022https://creativecommons.org/licenses/by-nc-nd/4.0/Trasplantament renalDiàlisiKidney transplantationDialysisinfo:eu-repo/semantics/article7304572023-09-21info:eu-repo/semantics/openAccess9315681