Influence of Recipient Insurance on the Outcome of Simultaneous Pancreas and Kidney Transplantation

Introduction

Simultaneous pancreas–kidney (SPK) transplantation is an established treatment for insulin-requiring diabetics with advanced chronic or end-stage kidney disease. Outcomes of SPK transplantation may vary according to socioeconomic factors such as funding sources. The aim of this study was to assess the association between insurance payer of transplant recipients and outcomes of SPK transplantation in the United States.

Methods

All adult primary SPK transplants performed in the United States between January 1, 1988, and December 31, 2017 were included, using data from the national Organ Procurement and Transplantation Network/Scientific Registry of Transplant Recipients database. A total of 19,849 adult SPK transplant recipients were included in the study, after excluding patients who had insurance sources other than Medicaid, Medicare, or private; dual insurance; or were lost at 90-day follow-up. Post-transplant outcomes were analyzed in terms of allograft and recipient survival.

Results

Recipients with private insurance had significantly lower risks of late kidney graft loss (hazard ratio [HR], 0.74), late pancreas graft loss (HR, 0.77), and late death (HR, 0.73) compared with those with Medicaid. Recipients with Medicare had a higher risk of late death (HR, 1.05). Private insurance recipients had better 10-year and 15-year kidney, pancreas, and patient graft survival rates across most racial/ethnic groups.

Conclusions

Recipient insurance status significantly influenced long-term outcomes after SPK transplantation. Transplant programs should consider publicly sponsored insurance status as a marker of poorer post-transplant survival to implement changes in both pre- and post-transplant strategies.