Analysis of United States (US) and non-US pancreas transplants as reported to the International Pancreas Transplant Registry (IPTR) and to the United Network for Organ Sharing (UNOS).
As of November 1998, more than 11,000 pancreas transplants had been reported to the IPTR, including more than 8,800 US and more than 2,600 non-US cases. The 1994-98 cases (> 4,500) were analyzed, including more than 4,000 US and more than 500 non-US transplants. For all US 1994-98 SPK transplants (n = 3,409), one-year patient, pancreas and kidney graft survival rates were 94%, 90% and 83%, respectively; for all PAK cases (n = 375), one-year patient and graft survival rates were 95% and 71%; and for all PTA cases (n = 181), one-year patient and graft survival rates were 95% and 64%, respectively. Recipient age had only a small impact on outcome, with one-year patient survival rates for all recipients < 45 years of 95% (n = 3,215) versus 91% for those > or = 45 years old (n = 758) (p = 0.005). Pancreas graft survival rates at one year for those < 45 versus > or = 45 years old were 84% versus 78% in the SPK (p < 0.02), 70% versus 78% in the PAK (p = 0.13), and 62% versus 79% in the PTA (p = 0.23) categories, respectively). Nearly one-third of US pancreas transplants for 1994-98 were done by the ED drainage technique. For SPK transplants, the one-year pancreas graft survival rate was 83% for BD (n = 2,369) and 82% for ED (n = 912) (p < or = 0.09). For PAK and PTA transplants, pancreas graft survival rates were significantly higher with BD, 74% (n = 261) and 68% (n = 115), respectively, at one year. The drawback for BD was the need for conversion to ED in 7% of the cases at one year and 11% at 2 years. For TS transplants, the pancreas graft loss due to rejection was very low for SPK transplants, 2% at one year versus 9% for PAK and 15% for PTA cases. The various initial maintenance immunosuppressive regimens (Tac + MMF, Tac + Aza, CsA + MMF, CsA + Aza) resulted in only minor differences in pancreas graft survival rates in the SPK cases (80-86% at 1 year), but in PAK and PTA cases the Tac + MMF combination was associated with significantly higher pancreas graft survival rates. For BD PAK transplant recipients given Tac + MMF, the one-year pancreas graft survival rate was 83% (n = 100). For the corresponding BD PTA group it was 75% (n = 44). For non-US cases the outcomes were similar. For non-US SPK transplants (n = 586), one-year patient, kidney and pancreas graft survival rates were 93%, 85% and 81%, respectively. Cox multivariate analyses and logistical regression were done in each recipient category to assess the factors that influence pancreas graft loss. BD was associated with a significantly lower risk than ED in all categories. Increasing donor age was a risk factor in most categories. MMF was associated with a decreased risk for graft loss in the SPK category, and Tac in the PAK and PTA categories.
Gruessner
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Department of Surgery, University of Minnesota, Minneapolis, USA.
Sutherland
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D000328:Adult; D005260:Female; D006085:Graft Survival; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007390:International Agencies; D016030:Kidney Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D012042:Registries; D012086:Reoperation; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data; D009927:Tissue and Organ Procurement / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D014481:United States
D007166:Immunosuppressive Agents