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Dialysis, Kidney Transplantation, or Pancreas Transplantation for Patients with Diabetes Mellitus and Renal Failure: A Decision Analysis of Treatment Options

Greg A. Knoll^* and Graham Nichol^,

*Division of Nephrology and Division of General Internal Medicine, Department of Medicine, University of Ottawa; and the Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Correspondence to Dr. Greg Knoll, Division of Nephrology, The Ottawa Hospital, Riverside Campus, Room 5-17, 1967 Riverside Drive, Ottawa, Ontario, Canada K1H 7W9. Phone: 613-738-8400 ext. 82536; Fax: 613-738-8337;

ABSTRACT. Patients with type 1 diabetes mellitus and end-stage renal disease may remain on dialysis or undergo cadaveric kidney transplantation, living kidney transplantation, sequential pancreas after living kidney transplantation, or simultaneous pancreas-kidney transplantation. It is unclear which of these options is most effective. The objective of this study was to determine the optimal treatment strategy for type 1 diabetic patients with renal failure using a decision analytic Markov model. Input data were obtained from the published medical literature, the United Network for Organ Sharing registry, and patient interviews. The outcome measures were life expectancy (in life-years [LY]) and quality-adjusted life expectancy (in quality-adjusted life-years [QALY]). Living kidney transplantation was associated with 18.30 LY and 10.29 QALY; pancreas after kidney transplantation, 17.21 LY and 10.00 QALY; simultaneous pancreas-kidney transplantation, 15.74 LY and 9.09 QALY; cadaveric kidney transplantation, 11.44 LY and 6.53 QALY; dialysis, 7.82 LY and 4.52 QALY. The results were sensitive to the value of several key variables. Simultaneous pancreas-kidney transplantation had the greatest life expectancy and quality-adjusted life expectancy when living kidney transplantation was excluded from the analysis. These data indicate that living kidney transplantation is associated with the greatest life expectancy and quality-adjusted life expectancy for type 1 diabetic patients with renal failure. Treatment strategies involving pancreas transplantation should be considered for patients with frequent metabolic complications of diabetes and for those patients who favor kidney-pancreas transplantation over kidney transplantation alone. For patients without a living donor, simultaneous pancreas-kidney transplantation is associated with the greatest life expectancy. E-mail: gknoll@ottawahospital.on.ca

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				P. de Jonge, G. M.-F. Ruinemans, F. J. Huyse, and P. M. ter Wee A simple risk score predicts poor quality of life and non-survival at 1 year follow-up in dialysis patients Nephrol. Dial. Transplant., December 1, 2003; 18(12): 2622 - 2628. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673