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

Introduction: Simultaneous Pancreas-Kidney (SPK) transplantation is an established treatment for insulin-requiring diabetics with either advanced chronic or end stage kidney disease (ESRD). The outcomes of SPK transplantation may vary according to socioeconomic factors such as recipient education. The aim of this study was to assess the association between education level of transplant recipients and outcomes of SPK transplantation in the United States. Methods: All adult primary simultaneous pancreas-kidney (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 (OPTN)/Scientific Registry of Transplant Recipients (SRTR) database. A total of 16,642 adult simultaneous pancreas-kidney (SPK) transplant recipients were included in the study, after excluding patients who data for education or were lost at 90-day follow-up. Post-transplant outcomes were analyzed in terms of allograft and recipient survival. Results: Recipients with higher education had significantly lower risks of late kidney graft loss (HR 0.88), late pancreas graft loss (HR 0.86), and late death (HR 0.82) compared to those with high school education or below. Higher education recipients had better 10-year and 15-year kidney, pancreas, and patient graft survival rates across most racial/ethnic groups. Conclusion: This large national study found that higher recipient education level was associated with improved long-term outcomes after simultaneous pancreas-kidney transplantation. The protective effect of higher education in recipients persisted after adjusting for other recipient, donor, and transplant factors. Keywords: SPK transplantation, education, socioeconomic factors, transplantation outcomes