Pancreas transplants for United States (US) and non-US cases as reported to the International Pancreas Transplant Registry (IPTR) and to the United Network for Organ Sharing (UNOS).

As of November 1997 more than 9,800 pancreas transplants had been reported to the IPTR, including more than 7,400 US and more than 2,400 non-US cases. Cases reported since the inception of UNOS in 1987 (more than 6,800 in the US and more than 2,000 from outside the US) were analyzed, with emphasis on 1994-97 cases. In the US, for all 1994-97 SPK transplants (n = 2,585), one-year patient, pancreas and kidney graft survival rates were 94%, 82% and 90%, respectively; for all PAK cases (n = 230), patient and graft survival rates at one year were 95% and 71%; and for all PTA cases (n = 117), patient and graft survival rates at one year were 93% and 62%, respectively. The 1994-97 pancreas survival rates in all categories were significantly higher than in previous eras. Analysis of bladder versus enteric drainage (BD vs ED) was made only for 1994-97 SPK cases since there were too few solitary ED cases for a comparison. One-year pancreas survival rates (all causes of failure included) were 83% for BD (n = 1,995) versus 80% for ED (n = 456) cases (p = NS). However, nearly 20% of SPK BD grafts had been converted to ED by 2 years. The pancreas retransplant success rates have also significantly increased over time. For 1994-97 pancreas retransplants (n = 92), the one-year graft survival rate was 72%. The technical failure (TF) rate for pancreas transplants has declined over time. For 1994-96 BD cases, the TF rate was 8% in SPK (n = 1,995), 13% in PAK (n = 174) and 11% in PTA (n = 90) cases. For SPK ED cases (n = 456) the TF rate was 11% (p = 0.06 vs SPK BD). The most common cause of technical loss was graft thrombosis, 5.5% for SPK, 10.2% for PAK and 6.7% for PTA. The TF rates were significantly higher in grafts from older (> 45 yrs) donors and donors who died from cardiovascular disease. The immunological graft loss rate has also significantly declined in all categories. For 1994-97, technically successful (TS) cases (DWFG censored), the rejection loss rate at one year was 2% in the SPK (n = 2,234), 9% in the PAK (n = 154), and 16% in the PTA (n = 78) categories. Cox multivariate analyses were done in each recipient category to assess for factors that influence risks of pancreas graft loss. Increasing donor age was a risk factor in all categories. HLA mismatching was important only in the solitary (PAK and PTA) categories. FK506 use was associated with a positive effect in all categories, as was MMF in the SPK category.