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E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Simultaneous pancreas–kidney (SPK) transplantation is a definitive treatment for patients with insulin-dependent diabetes mellitus and end-stage kidney disease. However, reliable predictors of postoperative kidney and pancreatic outcomes remain limited. This study aimed to investigate whether histologic findings from protocol kidney biopsies obtained 1 hour after transplantation—hereafter referred to as “baseline biopsies” — are associated with kidney function, pancreatic endocrine function, and survival after SPK.
We retrospectively analyzed 71 patients who underwent primary SPK at our institution from August 8, 2011 to October 2, 2022. The median age was 44.0 years (IQR: 40.5–51.5); 26 were male and 45 female. Baseline kidney biopsies were obtained from 71 patients. Histologic evaluation was based on the Banff classification and MAPI score. Kidney function was assessed by estimated glomerular filtration rate (eGFR) at the first post-discharge outpatient visit and by the occurrence of sustained eGFR <30 mL/min/1.73 m² lasting ≥84 days. Pancreatic endocrine function was evaluated with the glucagon stimulation test (ΔC-peptide; ΔCPR, ng/mL).
In the baseline kidney biopsies, arteriolar hyalinosis (ah) was absent in 61 patients and present (ah = 1–3) in 10. Over a mean follow-up of 70.9 months, 20 patients (28%) died or developed sustained eGFR <30 mL/min/1.73 m². Compared with the ah-negative group, the ah-positive group tended to have a lower eGFR at the first post-discharge visit: 45.4 (38.9–51.7) vs. 60.0 (47.5–69.0) mL/min/1.73 m² (p=0.054). The incidence of sustained eGFR <30 mL/min/1.73 m² was significantly higher in the ah-positive group than in the ah-negative group (40.0% vs. 8.2%, p = 0.0014), and the proportion who died was also significantly higher (50.0% vs. 11.5%, p = 0.0026). Kaplan–Meier curves were compared with the log-rank test, which showed a higher cumulative incidence of the composite endpoint of death or sustained eGFR <30 mL/min/1.73 m² in the ah-positive group (p=0.0001; Figure). In multivariable Cox regression analysis adjusted for age, sex, and donor age, ah remained independently associated with composite outcome of death or sustained eGFR <30 mL/min/1.73 m² (hazard ratio [HR]: 3.99; 95% confidence interval [CI]: 1.39–11.49; p = 0.01). Additionally, pancreatic endocrine function at discharge was significantly lower in the ah-positive group, with ΔCPR of 1.34 [1.21–1.84] vs. 2.73 [2.14–3.65] ng/mL (p = 0.0096).
Baseline kidney biopsies —particularly the presence of arteriolar hyalinosis—may predict subsequent kidney dysfunction, diminished pancreatic endocrine function, and higher risk of death after SPK. Our findings suggest that early biopsy findings may aid risk stratification and postoperative management.
