Pancreas transplantation in the United States (US) and non-US as reported to the United Network for Organ Sharing (UNOS) and the International Pancreas Transplant Registry (IPTR).
As of November 1996, more than 8,800 pancreas transplants had been reported to the IPTR. There were 6,500 performed in the US, including more than 5,800 since the inception of the UNOS Registry in October 1987, and more than 1,000 in 1995. In Europe, more than 2,100 cases were reported to the IPTR, while fewer than 200 have been done in other locations. This report analyzes cases reported since 1987. In the US, BD has been used for the majority (92%). However, ED has recently increased in popularity, and for 1995, 15% of US cases were done by this method. In the SPK category results for 1994-1996 BD (n = 1,510) and ED (n = 221) were comparable, with one-year GSRs of 62% and 77%, respectively. When the 1987-1996 US data for BD cases were analyzed according to the 3 major recipient categories, SPK transplants (n = 3,989); PAK transplants (n = 375) and PAK transplants (n = 229), patient survival rates were no different (92%, 92% and 91%, respectively at one year). But one-year pancreas GSRs were significantly higher (p = 0.0001) in the SPK than in the PAK and PTA categories (79%, 60% and 57%, respectively). In the SPK group, the one-year kidney GSR was 88%. Retransplants and primary transplants fared similarly in the SPK category, with one-year GSRs of 79% (n = 3,947) and 77% (n = 42), respectively. But in the PAK category, primary transplants did better, 62% (n = 275) versus 47% (n = 100) functioning at one year. The PTA category outcome was also better for primary than retransplants, with GSRs of 57% (n = 191) and 51% (n = 38) at one year. An improvement in GSRs could be shown over the analyzed time period for all categories; for 1994-1996 cases in the SPK (n = 1,516), PAK (n = 141) and PTA (n = 64) categories, one-year pancreas GSRs were 81%, 71% and 64%, respectively (p = 0.004). The kidney GSR for 1994-96 SPK cases was 88% at one year. Preservation had minimal impact on outcome. In the SPK category, one-year GSRs for pancreases stored less than 12 (n = 1,400), 12-24 (n = 2,256) and more than 24 (n = 195) hours were 78%, 80% and 76%, respectively. The impact of FK506 immunosuppression on pancreas transplant survival was also analyzed for 1994-1996 cases. The results were comparable to those with CsA. For SPK cases, one-year GSRs were 82% with CsA (n = 1,247) and 81% with FK506 (n = 257). The one-year immunological loss rates were 2% and 3%, respectively. For PAK cases, one-year GSRs were 84% for FK506- (n = 42) and 65% for CsA- (n = 97) treated recipients (p < 0.04), and the immunological loss rates at one year were 11% and 7%, respectively. In PTA cases, the one-year GSRs were 66% with CsA (n = 37) and 64% with FK506 (n = 26) with immunological loss rates of 9% and 0%, respectively (p > 0.2). Outcomes were also compared according to whether recipients underwent induction immunotherapy with ALG/ATG/ATS, OKT3, or neither. In the SPK category, GSRs were 81% with OKT3 (n = 1,600), 75% with ALG/ATG/ATS (n = 1,715) and 75% with neither (n = 45) (p < 0.001). In the PAK category, the use of OKT3 (n = 81) was associated with lower graft survival rates than when ALG/ATG/ATS (n = 220) or neither (n = 49) was given (43%, 62%, and 54% at one year, respectively). In the PTA category the use of ALG/ ATG/ATS (n = 132) or OKT3 (n = 76) was associated with significantly higher graft survival (59% and 57%, respectively) than when neither (n = 13) was used (26% at one year). The effect of HLA-A,-B and -DR mismatching on outcome for US cases was determined on both overall graft survival rates and on risks for immunological loss. For SPK cases, the pancreas GSRs were significantly higher (p < 0.04) with zero-mismatched grafts (n = 30) than with higher degrees of mismatches (85% at one year versus 69%, 76% and 79% with one [n = 67], 2-3 [n = 925] and 4-6 [n = 2,836] mismatches, respectively). For PAK cases GSRs were progressively higher with decreasing numbers of mismatches (100%, 75%, 58% and 53% at one year with zero [n = 7], one [n = 35], 2-3 [
Gruessner
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Department of Surgery, University of Minnesota Minneapolis, USA.
Sutherland
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D000328:Adult; D004359:Drug Therapy, Combination; D005060:Europe; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007391:International Cooperation; D016030:Kidney Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009926:Organ Preservation; D016035:Pancreas Transplantation / Q000276:immunology / Q000401:mortality / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology; D044469:Racial Groups; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data; D014481:United States
D007166:Immunosuppressive Agents