Sohail KHAN, Hannah COHEN, Dayanna ZULUAGA, Quentin PALONE, Katherine CONNORS, Yang YU, Giovanni FADDOUL, Meng-Hao LI, Naoru KOIZUMI, Jorge ORTIZ
Experimental and Clinical Transplantation - 2026;24(8):626-639
Objectives: Seven-day graft loss after simultaneous pancreas-kidney transplant remains incompletely characterized. This retrospective registry analysis examined the incidence, etiologies, and predictors of 7-day graft loss after simultaneous pancreas-kidney transplant. Materials and Methods: We analyzed all adult deceased donor simultaneous pancreas-kidney transplant recipients from the Organ Procurement and Transplantation Network (2015-2024). We compared recipients who had 7-day graft loss (ie, pancreas graft failure, kidney graft failure, or death within 7 postoperative days [non-death-censored]) with recipients who had achieved at least 1-year dual-graft survival. We used multivariable logistic regression to identify predictors. Results: Among 6362 recipients, 304 (4.8%) experienced 7-day graft loss. Pancreas graft failure predominated (94.4% vs 12.5%; P < .001), followed by kidney graft failure (32.2% vs 12.4%; P < .001). Thrombosis was the leading etiology, followed by primary nonfunction. Twenty-four recipients lost both allografts simultaneously; all 16 deaths within the 7-day analysis period occurred within this subset. In a model restricted to recipients with pretransplant C-peptide values, body mass index (calculated as weight in kilograms divided by height in meters squared) >=30 (odds ratio 1.747; P = .001), donor hypertension (odds ratio 1.767; P = .035), male sex (odds ratio 0.699; P = .005), and each 0.1 ng/mL C-peptide decrement (odds ratio 1.006; P = .029) independently predicted 7-day graft loss. Dialysis vintage predicted simultaneous dual-graft failure and early death. Conclusions: Seven-day graft loss complicated nearly 1 in 20 simultaneous pancreas-kidney transplant procedures. These predictors constitute actionable targets for preoperative risk stratification and donor-recipient matching.
