Pancreas transplant results in United Network for Organ Sharing (UNOS) United States of America (USA) Registry with a comparison to non-USA data in the International Registry.
As of 1993, more than 5,000 pancreas transplants were reported to the International Pancreas Transplant Registry. More than 3,600 were performed in the USA, including 3,000 since the inception of the UNOS Registry in October, 1987. The BD technique was used for 96% of USA cases but for only 63% of non-USA cases. In the overall analysis of USA BD cadaveric pancreas transplants reported to the Registry by November 1993 (n = 2,464), patient survival and pancreas graft function survival rates at one year were 91% and 72%, respectively, 87% and 67% at 2 years, and 84% and 62% at 3 years. When the USA data for BD cases were analyzed according to the 3 major recipient categories (simultaneous pancreas/kidney transplants [SPK] [n = 2,112]; pancreas after kidney transplants [PAK] [n = 205]; and pancreas transplants alone [PTA] [n = 147]), patient survival rates were no different (91%, 92%, and 91% at one year, respectively), but pancreas graft survival rates were significantly higher in the SPK than in the PAK and PTA categories (76%, 47%, and 48%, at one year, respectively). In the SPK group, kidney graft survival rates at one year were 85%. Although the overall results were not as good for non-USA as for USA pancreas transplants, this was probably because the results with non-BD techniques were not as good as when BD was used, and in Europe more than one-third of the cases used techniques other than BD. The patient, pancreas, and kidney graft survival rates for BD SPK transplants in Europe (n = 522) and other non-USA locations (n = 64) were similar to those in the USA: in Europe 93%, 77%, and 84%, respectively, at one year. The graft survival rates for solitary pancreas transplants, however, were higher in the USA. Outcomes were also compared according to whether induction immunotherapy in USA recipients included ALG/ATG, OKT3, or neither. In the SPK category, there was no difference among the protocols: one-year graft survival rates were 76% with ALG/ATG (n = 1,141), 78% with OKT3 (n = 673), and 71% with neither (n = 249). In the PAK category, the use of OKT3 (n = 37) was associated with lower graft survival rates than when ALG/ATG (n = 133) or neither (n = 34) were given: 26%, 58%, and 53% at one year, respectively.(ABSTRACT TRUNCATED AT 400 WORDS)
Sutherland
D E
DE
Department of Surgery, University of Minnesota, Minneapolis.
Moudry-Munns
K
K
Gruessner
A
A
D000328:Adult; D001208:Asia / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D006085:Graft Survival; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D010182:Pancreatic Diseases / Q000208:ethnology / Q000601:surgery; D012042:Registries / Q000706:statistics & numerical data*; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology