Islet-after-kidney transplantation versus kidney alone in kidney transplant recipients with type 1 diabetes (KAIAK): a population-based target trial emulation in France
Authors' conclusion
In kidney transplant recipients with type 1 diabetes, IAK transplantation was associated with a significantly better patient-graft survival compared with kidney transplantation alone, mainly due to a protective effect on the risk of death. These results potentially serve as compelling grounds for advocating wider access to islet transplantation in patients with type 1 diabetes undergoing kidney transplant, as reimbursement of islet transplantation is provided in few countries worldwide.
Study context
- Population
- Kidney transplant recipients with T1D in France, 2000–2017; 15 centresmatched cohort
- Participants
- 40 vs 80
- Exposure
- Islet-after-kidney transplantation vs kidney transplantation alone
- Islet-after-kidney (IAK)n = 40
- Kidney alonen = 80reference
- Outcome
- Patient-graft survival: composite of death, re-transplantation, or return to dialysis
Methodological detailstarget trial emulation, population-based, nationwide registry (CRISTAL), 1:2 matching on time-dependent propensity scores
- Target trial emulation
- Population-based
- Nationwide registry (CRISTAL)
- 1:2 matching on time-dependent propensity scores
Main finding
As reported in the abstract
- Death
- Re-transplantation
- Return to dialysis)
HR for death, re-transplantation or return to dialysis
0.44
95% CI 0.23–0.88
P = 0.022
Events by group
Observational data: associations, not effects.
Further findings
| Outcome | HR (CI) | P value | |
|---|---|---|---|
| Death | 0.41 (0.13–0.91) | P = 0.042 | |
| 0.10.31310Hazard ratio (log scale) |
| Outcome | Estimate | P value |
|---|---|---|
| Death-censored graft survivalNo meaningful association | 0.73 (CI 0.30–1.89) | P = 0.36 |
Original publication
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