Pancreas transplant outcomes for United States (US) cases as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR)

Angelika C Gruessner, David E R Sutherland
Clinical Transplants 2008, : 45-56
From December 16, 1966 to December 31, 2008 more than 30,000 pancreas transplants have been reported to the International Pancreas Transplant Registry (IPTR), including > 22,000 from the United States and > 8,000 from outside the US. This report focused on the most recent outcomes for pancreas transplants performed in the US, since we had reliable follow-up information available for US cases only at this time. Between 2004 and 2008 the most common pancreas transplant category was a combined pancreas/kidney transplant (SPK) (73%). Nineteen percent of diabetic patients had already received a kidney transplant before undergoing a pancreas transplant (PAK). In those cases, 76% of all kidneys came from a living donor. Pancreas transplants alone (PTA) accounted for 9% of all pancreas transplants in diabetic patients. The number of pancreas transplants for diabetic patients decreased over the last 5 years, and the decrease was highest in PAK, followed by PTA and SPK. During this time period, the patient age at transplant increased due to an increased number of patients with type 2 diabetes reported as reason for transplantation. The decrease in the number of pancreas transplants provided the opportunity for better selection of deceased donors. We noticed a significant decrease in the age of the deceased donor. Only 6-8% of all reported donors were 45 years of age or older, and the majority of donors were between 15 and 30 years old. In all three pancreas transplant categories (SPK, PAK, and PTA), the majority of patients received antibody therapy for induction and a maintenance protocol of Tacrolimus in combination with MMF. In a growing number of patients, the maintenance protocol was Sirolimus based. In all protocols a strong trend of steroids avoidance could be seen and accounted for one third of all transplants. The overall outcome of pancreas transplantation improved significantly. Patient survival at one year is now better than 95% and reached 90% at 3 years post-transplantation. Pancreas graft function also improved and is still significantly better in SPK than in PAK or PTA. One year graft survival reached 85% in SPK compared to 79% in solitary pancreas transplants. While the overall rate of technical problems decreased, immunological graft loss is still a problem in solitary transplants. While the immunological pancreas graft loss rate at one year was 2% in SPK, it was 6% for PAK and PTA. The use of young donors with short preservation time showed a significant decrease for the risk of graft failure in all 3 categories. This was especially important since the failure of a graft was the factor with the highest impact on patient survival. In summary, with modern immunosuppression regimens and careful donor selection, patient survival and pancreas transplant graft function can be further improved in all three pancreas transplant categories.

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