{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T10:16:49Z","timestamp":1770977809606,"version":"3.50.1"},"reference-count":50,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Simultaneous pancreas\u2013kidney transplantation (SPK) is the standard treatment for selected patients with type 1 diabetes mellitus and end-stage renal disease. Textbook Outcome (TO), a composite of perioperative and long-term quality indicators, provides a benchmark for optimal results. This study analyzed factors associated with failure to achieve TO after SPK. Methods: We retrospectively analyzed 119 SPK recipients (1980\u20132022). TO was defined according to IQTIG criteria: (i) patient survival \u2265 3 years, (ii) insulin independence at discharge, (iii) kidney function at discharge (GFR \u2265 20 mL\/min), (iv) insulin-free survival \u2265 3 years, and (v) sustained kidney function \u2265 3 years. Predictors of TO failure were identified by logistic regression. Long-term survival was assessed by Kaplan\u2013Meier analysis. Results: Ninety-two patients were eligible for TO assessment; 52% achieved TO. Compared with TO patients, non-TO patients had older donors (median 30 vs. 25.5 years, p = 0.017), older recipients (44 vs. 39 years, p = 0.012), longer kidney cold ischemia time (CIT; 13.0 vs. 9.7 h, p = 0.005), and more pancreatic complications (p = 0.009). In multivariate analysis, donor age (OR 1.050, p = 0.030) and kidney CIT (OR 1.180, p = 0.029) independently predicted TO failure. Cut-offs were donor age \u2264 37 years and kidney CIT \u2264 11.5 h. Patients achieving TO had significantly better long-term survival (15 years, p = 0.0077). Conclusions: Younger donor age and shorter kidney CIT independently predict TO achievement, which is associated with superior long-term survival. Optimized donor selection and perioperative management may improve SPK outcomes.<\/jats:p>","DOI":"10.3390\/jcm15041465","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T09:09:19Z","timestamp":1770973759000},"page":"1465","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Beyond Survival: Factors Driving Textbook Outcome After Simultaneous Pancreas\u2013Kidney Transplantation\u2014A Retrospective Analysis"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-1716-3547","authenticated-orcid":false,"given":"Anke","family":"Mittelst\u00e4dt","sequence":"first","affiliation":[{"name":"Department of General and Visceral Surgery, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9989-3238","authenticated-orcid":false,"given":"Frederik","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maximilian","family":"Brunner","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2537-5824","authenticated-orcid":false,"given":"Christian","family":"Krautz","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Florian","family":"Struller","sequence":"additional","affiliation":[{"name":"General and Visceral Surgery, Krankenhaus Wasserburg, Gabersee 1, 83512 Wasserburg am Inn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hendrik","family":"Apel","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Wullich","sequence":"additional","affiliation":[{"name":"Department of Urology and Pediatric Urology, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katharina","family":"Heller","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Friedrich-Alexander-University (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mirian","family":"Opgenoorth","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Friedrich-Alexander-University (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Schiffer","sequence":"additional","affiliation":[{"name":"Department of Nephrology and Hypertension, Friedrich-Alexander-University (FAU), 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Gr\u00fctzmann","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1175-4505","authenticated-orcid":false,"given":"Georg F.","family":"Weber","sequence":"additional","affiliation":[{"name":"Department of General and Visceral Surgery, Friedrich-Alexander-University (FAU), Krankenhausstra\u00dfe 12, 91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,13]]},"reference":[{"key":"ref_1","first-page":"171","article-title":"The rise and potential fall of pancreas transplantation","volume":"124","author":"Dholakia","year":"2017","journal-title":"Br. Med. Bull."},{"key":"ref_2","unstructured":"Bundes\u00e4rztekammer (2022). Neubekanntmachung der Richtlinie Gem. \u00a7 16 Abs. 1 S. 1 Nrn. 2 u. 5 TPG f\u00fcr die Wartelistenf\u00fchrung und die Organvermittlung zur Pankreastransplantation und Kombinierten Pankreas-Nierentransplantation, Deutschen \u00c4rzteblatt."},{"key":"ref_3","first-page":"827","article-title":"Allotransplantation of the pancreas and duodenum along with the kidney in diabetic nephropathy","volume":"61","author":"Kelly","year":"1967","journal-title":"Surgery"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/j.gtc.2018.01.009","article-title":"Pancreas Transplantation for Patients with Type 1 and Type 2 Diabetes Mellitus in the United States: A Registry Report","volume":"47","author":"Gruessner","year":"2018","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1007\/s11428-022-00934-0","article-title":"Update zur Pankreastransplantation","volume":"18","year":"2022","journal-title":"Die Diabetol."},{"key":"ref_6","unstructured":"(2025, November 12). Deutsche Stiftung Organtransplantation. Available online: https:\/\/www.dso.de\/organspende\/statistiken-berichte\/organtransplantation."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1053\/ajkd.2003.50057","article-title":"Long-term survival following simultaneous kidney-pancreas transplantation versus kidney transplantation alone in patients with type 1 diabetes mellitus and renal failure","volume":"41","author":"Reddy","year":"2003","journal-title":"Am. J. Kidney Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2757","DOI":"10.1097\/TP.0000000000001628","article-title":"Transplant Center Volume and the Risk of Pancreas Allograft Failure","volume":"101","author":"Alhamad","year":"2017","journal-title":"Transplantation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1007\/s00125-007-0860-4","article-title":"Simultaneous islet-kidney vs pancreas-kidney transplantation in type 1 diabetes mellitus: A 5 year single centre follow-up","volume":"51","author":"Gerber","year":"2008","journal-title":"Diabetologia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1007\/s11560-020-00422-w","article-title":"Was gibt es Neues zur kombinierten Nieren-Pankreas-Transplantation?","volume":"15","author":"Aly","year":"2020","journal-title":"Der Nephrol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1915","DOI":"10.1016\/S0140-6736(98)07513-8","article-title":"Effect of simultaneous pancreas-kidney transplantation on mortality of patients with type-1 diabetes mellitus and end-stage renal failure","volume":"353","author":"Smets","year":"1999","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"652","DOI":"10.1007\/s00104-002-0607-1","article-title":"Morbidity following simultaneous pancreas\/kidney transplantation","volume":"74","author":"Wullstein","year":"2003","journal-title":"Chirurg"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ai Li, E., Farrokhi, K., Zhang, M.Y., Offerni, J., Luke, P.P., and Sener, A. (2023). Heparin Thromboprophylaxis in Simultaneous Pancreas-Kidney Transplantation: A Systematic Review and Meta-Analysis of Observational Studies. Transpl. Int., 36.","DOI":"10.3389\/ti.2023.10442"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1007\/s00261-014-0164-3","article-title":"Multi detector computed tomography (MDCT) for the diagnosis of early complications after pancreas transplantation","volume":"39","author":"Vincent","year":"2014","journal-title":"Abdom. Imaging"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2472","DOI":"10.1016\/j.transproceed.2009.06.165","article-title":"Relaparotomy after pancreas transplantation: Causes and outcomes","volume":"41","author":"Manrique","year":"2009","journal-title":"Transplant. Proc."},{"key":"ref_16","first-page":"509","article-title":"Pancreas transplantation-clinic, technique, and histological assessment","volume":"42","author":"Amann","year":"2021","journal-title":"Pathologe"},{"key":"ref_17","first-page":"958","article-title":"Perspective of simultaneous pancreas-kidney transplantation","volume":"138","author":"Schenker","year":"2013","journal-title":"Dtsch. Med. Wochenschr."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"434","DOI":"10.12659\/AOT.910014","article-title":"Pancreas Donor Risk Index but Not Pre-Procurement Pancreas Allocation Suitability Score Predicts Pancreas Graft Survival: A Cohort Study from a Large German Pancreas Transplantation Center","volume":"23","author":"Ayami","year":"2018","journal-title":"Ann. Transplant."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1111\/j.1600-6143.2009.02996.x","article-title":"Systematic evaluation of pancreas allograft quality, outcomes and geographic variation in utilization","volume":"10","author":"Axelrod","year":"2010","journal-title":"Am. J. Transplant."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"372","DOI":"10.5500\/wjt.v10.i12.372","article-title":"Donor risk factors in pancreas transplantation","volume":"10","year":"2020","journal-title":"World J. Transplant."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/S0039-6060(05)80012-1","article-title":"Multivariate analysis of donor risk factors for pancreas allograft failure after simultaneous pancreas-kidney transplantation","volume":"118","author":"Douzdjian","year":"1995","journal-title":"Surgery"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1111\/ajt.15275","article-title":"OPTN\/SRTR 2017 Annual Data Report: Pancreas","volume":"19","author":"Kandaswamy","year":"2019","journal-title":"Am. J. Transplant."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1097\/01.TP.0000137198.09182.A2","article-title":"Technical failures after pancreas transplants: Why grafts fail and the risk factors--a multivariate analysis","volume":"78","author":"Humar","year":"2004","journal-title":"Transplantation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2401","DOI":"10.1111\/ajt.13734","article-title":"HLA-A, -B, -C, -DR, and -DQ Matching in Pancreas Transplantation: Effect on Graft Rejection and Survival","volume":"16","author":"Rudolph","year":"2016","journal-title":"Am. J. Transplant."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1002\/bjs.10729","article-title":"Using textbook outcome as a measure of quality of care in oesophagogastric cancer surgery","volume":"105","author":"Voncken","year":"2018","journal-title":"Br. J. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"156","DOI":"10.1016\/j.ejso.2012.10.007","article-title":"Focusing on desired outcomes of care after colon cancer resections; hospital variations in \u2018textbook outcome\u2019","volume":"39","author":"Kolfschoten","year":"2013","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"3470","DOI":"10.1007\/s00268-020-05625-9","article-title":"Textbook Outcomes in Liver Transplantation","volume":"44","author":"Moris","year":"2020","journal-title":"World J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1007\/s11695-018-03642-1","article-title":"Textbook Outcome: An Ordered Composite Measure for Quality of Bariatric Surgery","volume":"29","author":"Poelemeijer","year":"2019","journal-title":"Obes. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1002\/jso.26136","article-title":"Analysis of textbook outcomes among patients undergoing resection of retroperitoneal sarcoma: A multi-institutional analysis of the US Sarcoma Collaborative","volume":"122","author":"Wiseman","year":"2020","journal-title":"J. Surg. Oncol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1097\/SLA.0000000000003451","article-title":"Textbook Outcome: Nationwide Analysis of a Novel Quality Measure in Pancreatic Surgery","volume":"271","author":"Mackay","year":"2020","journal-title":"Ann. Surg."},{"key":"ref_31","unstructured":"Institute for Quality Assurance and Transparency in Health Care (IQTIG) (2025, November 12). Qualit\u00e4tsindikatoren f\u00fcr Pankreas- und Pankreas-Nierentransplantationen. Available online: https:\/\/iqtig.org\/qs-verfahren\/pntx\/."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1111\/tri.13845","article-title":"Recipient age and outcome after pancreas transplantation: A retrospective dual-center analysis","volume":"34","author":"Messner","year":"2021","journal-title":"Transpl. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"810","DOI":"10.1111\/tri.12754","article-title":"Pancreas transplantation in older patients is safe, but patient selection is paramount","volume":"29","author":"Scalea","year":"2016","journal-title":"Transpl. Int."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e13","DOI":"10.1097\/TP.0000000000000554","article-title":"The effect of recipient age on outcome after pancreas transplantation","volume":"99","author":"Laurence","year":"2015","journal-title":"Transplantation"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e000916","DOI":"10.1136\/bmjdrc-2019-000916","article-title":"Outcomes of pancreas transplantation in older diabetic patients","volume":"8","author":"Amor","year":"2020","journal-title":"BMJ Open Diabetes Res. Care"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1111\/j.1600-6143.2007.01818.x","article-title":"Patient and graft survival implications of simultaneous pancreas kidney transplantation from old donors","volume":"7","author":"Salvalaggio","year":"2007","journal-title":"Am. J. Transplant."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1097\/00000658-200002000-00017","article-title":"Decreased surgical risks of pancreas transplantation in the modern era","volume":"231","author":"Humar","year":"2000","journal-title":"Ann. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1016\/S0041-1345(98)01579-6","article-title":"Potential use of marginal donors for pancreas transplantation","volume":"31","author":"Bonham","year":"1999","journal-title":"Transplant. Proc."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"100570","DOI":"10.1016\/j.xkme.2022.100570","article-title":"Cold Ischemia Time, Kidney Donor Profile Index, and Kidney Transplant Outcomes: A Cohort Study","volume":"5","author":"Lum","year":"2023","journal-title":"Kidney Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1038\/ki.2014.304","article-title":"Each additional hour of cold ischemia time significantly increases the risk of graft failure and mortality following renal transplantation","volume":"87","author":"Debout","year":"2015","journal-title":"Kidney Int."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1111\/tri.13121","article-title":"Impact of cold ischemia time on the outcomes of kidneys with Kidney Donor Profile Index \u226585%: Mate kidney analysis\u2014A retrospective study","volume":"31","author":"Sampaio","year":"2018","journal-title":"Transpl. Int."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1042","DOI":"10.1111\/j.1600-6143.2004.00457.x","article-title":"Effects of organ preservation, ischemia time and caspase inhibition on apoptosis and microcirculation in rat pancreas transplantation","volume":"4","author":"Drognitz","year":"2004","journal-title":"Am. J. Transplant."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e13035","DOI":"10.1111\/ctr.13035","article-title":"Optimizing outcomes in pancreas transplantation: Impact of organ preservation time","volume":"31","author":"Rudolph","year":"2017","journal-title":"Clin. Transplant."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Kj\u00f8sen, G., Rydenfelt, K., Horneland, R., Aandahl, E.M., Line, P.D., Dorenberg, E., Berstad, A.E., Brabrand, K., Hagen, G., and Pischke, S.E. (2021). Early detection of complications in pancreas transplants by microdialysis catheters, an observational feasibility study. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0247615"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1159","DOI":"10.21037\/gs-24-121","article-title":"Dueling with the dual artery blood supply in pancreas transplantation: Why replace the Y?","volume":"13","author":"Fridell","year":"2024","journal-title":"Gland. Surg."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1111\/j.1399-0012.2005.00378.x","article-title":"Pancreas transplant outcomes for United States (US) and non-US cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR) as of June 2004","volume":"19","author":"Gruessner","year":"2005","journal-title":"Clin. Transplant."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1111\/j.1399-0012.2008.00809.x","article-title":"What happens to the kidney in an SPK transplant when the pancreas fails due to a technical complication?","volume":"22","author":"Hill","year":"2008","journal-title":"Clin. Transplant."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1097\/TP.0b013e31822dc36b","article-title":"Early pancreas graft failure is associated with inferior late clinical outcomes after simultaneous kidney-pancreas transplantation","volume":"92","author":"Norman","year":"2011","journal-title":"Transplantation"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"988","DOI":"10.2215\/CJN.04940908","article-title":"Twelve-month pancreas graft function significantly influences survival following simultaneous pancreas-kidney transplantation","volume":"4","author":"Weiss","year":"2009","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Ji, M., Wang, M., Hu, W., Ibrahim, M., Lentine, K.L., Merzkani, M., Murad, H., Al-Hosni, Y., Parsons, R., and Wellen, J. (2022). Survival After Simultaneous Pancreas-Kidney Transplantation in Type 1 Diabetes: The Critical Role of Early Pancreas Allograft Function. Transpl. Int., 35.","DOI":"10.3389\/ti.2022.10618"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1465\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T09:32:23Z","timestamp":1770975143000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1465"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,13]]},"references-count":50,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041465"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041465","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,13]]}}}