Results of pancreas transplantation in the United States for 1987-90 from the United Network for Organ Sharing (UNOS) Registry with comparison to 1984-87 results.
An outcome analysis was performed on pancreas transplants in the United States reported to the United Network for Organ Sharing (UNOS) Registry from its inception on 1 October 1987 to 21 October 1990 (n=1021). These cases comprise nearly one-third of the 3082 pancreas transplants reported to the International Pancreas Transplant Registry (1819 U.S., 1263 non-U.S.) from 1 December 1966 to 31 December 1990, including 619 in 1990 (528 U.S., 91 non-U.S.).  Nearly all pancreas transplants in the U.S. during the 1987-90 period were by the bladder-drainage (BD) technique (92%).  The overall patient and pancreas graft actuarial survival rates were 92% and 72% at 1 year.  Patient survival rates were similar in all recipient categories, but pancreas graft survival rates were significantly higher (p less than 0.001) in recipients of a simultaneous pancreas and kidney (SPK) transplant (n=883) than in recipients of a pancreas after a kidney (PAK, n=112) or a pancreas transplant alone (PTA, n=71), being 77%, 52%, and 54%, respectively, at 1 yr.  Kidney graft survival at 1 yr in U.S. SPK recipients was 86%.  Most grafts (81%) were preserved in University of Wisconsin (UW) solution, and more than half were stored greater than 12 hours, with no difference in outcome with increasing duration of storage. At 1 yr, functional survival rates were 72% for U.S. pancreas grafts stored for either less than 12 (n=439), 12-24 (n=422), or 24-30 h (n=42).  For grafts stored greater than 30 h (n=8), the 1-yr functional survival rate was 50% (p=ns versus the other storage times).  On univariate analysis, no effect of HLA antigen mismatching on outcome for 1987-90 U.S. cases could be discerned.  The results in the UNOS Registry were compared to the results for U.S. cases in the International Pancreas Transplant Registry performed between 1 January 1984 and 30 September 1987.  In all recipient categories the pancreas graft functional survival rates were significantly higher in the 1987-90 (UNOS) than in the 1984-87 (pre-UNOS) era.  A Cox multivariate analysis of 1984-90 cases showed the relative risk for pancreas graft loss to be significantly less (p less than 0.05) with bladder-drainage, with simultaneous transplantation of the kidney, with use of UW solution for preservation, and with 0-1 HLA-A, B, DR or 0 HLA-DR mismatches.(ABSTRACT TRUNCATED AT 400 WORDS)
Department of Surgery, University of Minnesota, Minneapolis.
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Sutherland
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Gillingham
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Moudry-Munns
D006085:Graft Survival; D006680:HLA Antigens; D006801:Humans; D016030:Kidney Transplantation / Q000639:trends; D016031:Liver Transplantation / Q000639:trends; D015999:Multivariate Analysis; D009926:Organ Preservation / Q000639:trends; D016035:Pancreas Transplantation / Q000706:statistics & numerical data* / Q000639:trends; D012042:Registries; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data* / Q000639:trends; D016896:Treatment Outcome; D014481:United States