Analysis of United States (US) and non-US pancreas transplants reported to the United network for organ sharing (UNOS) and the international pancreas transplant registry (IPTR) as of October 2001.
As of October 10, 2001, > 17,000 pancreas transplant had been reported to the IPTR, > 11,500 in the US and > 4,700 outside the US. An era analysis of US cases from 1987 to 2001 showed a progressive improvement in outcome (p < 0.04), with pancreas transplant graft survival rates (GSRs) going from 75% to 83% at one year for SPK cases, from 50% to 78% for PAK cases, and from 49% to 78% for PTA cases. The improvements were due both to decreases in technical failure (TF) rates (from 14% to 7% in SPK, 23% to 8% in PAK, and 23% to 10% in PTA) and immunological failure rates (going from 7% to 2% for SPK, from 25% to 2% for PAK, and from 28% to 4% for PTA cases). The proportion of recipients > 45 years old increased from 5% to 25%, and the improved outcomes encompassed the older patients as well. In patients > 45 years old, SPK pancreas GSRs at one year increased from 74% to 80% (p < 0.007). Pancreas GSRs were also similar for recipients reported to have Type 1 or Type 2 diabetes (at one year, 84% and 83%, respectively for 1997-2001 SPK transplants), the latter designated in 5% of the recipients. Contemporary pancreas transplant outcomes were calculated separately for 1997-2001 US and non-US cases. US patient survival rates at one year were > or = 95% in each recipient category, with one year pancreas GSRs of 83% for SPK (n = 3885), 79% for PAK (n = 630), and 78% for PTA (n = 240) (p = 0.0002). The immunological graft failure rates for 1997-2001 US SPK, PAK and PTA cases were 4%, 6%, and 8% at one year (p = 0.0001). There was a progressive increase in the use of ED (as opposed to BD) for duct management, to 67% for 1997-2001 US SPK transplants, 51% for PAK and 42% for PTA. Of US SPK ED transplants, 22% had venous drainage via the portal system. US pancreas GSRs were not significantly different for 1997-2001 ED (n = 2,519) and BD (n = 1,260) US SPK transplants (82% and 85%, respectively, at one year), nor was there a difference in pancreas GSRs for systemic (n = 1,958) versus portal (n = 557) venous-drained ED SPK transplants (82% vs. 84% at one year). Kidney GSRs were slightly higher for ED versus BD US SPK cases, 93% versus 91% at one year (p = 0.03). Duct management did matter for solitary (PAK and PTA) pancreas transplants. Pancreas GSRs for PAK recipients were 85% at one year for BD (n = 316) versus 74% for ED (n = 303) US transplants (p < 0.02); for PTA 81% (n = 168) versus 74% (p > or = 0.37). However, BD transplants were associated with a 12% conversion rate to ED by two years posttransplant. Recipient age made little difference for outcome in any category. Indeed, in the PTA category GSRs were significantly higher for US recipients > 45 years old (n = 66) than 21-45 years old (n = 216), 85% versus 77% at 1 year (p < or = 0.10). TAC + MMF was the dominant maintenance immunosuppressant for 1999-2001 US cases (> 70%). In an analysis of outcome according to type of anti-T-cell antibody agents (depleting vs. non-depleting vs. none) for induction therapy in TAC + MMF treated recipients, there were no differences in GSRs in any of the categories. In regard to non-US cases, the overwhelming majority were in the SPK category (n = 1,649 for 1997-2001), with a one year pancreas GSR of 82%, not significantly different than for US cases. In summary, pancreas transplant graft survival rates were nearly 80% at one year in recipients of solitary (PAK and PTA) pancreas transplants, and > 80% in SPK recipients for 1997-2001 cases. The outcome continues to improve as increasing numbers of solitary pancreas transplants are done.
Gruessner
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IPTR, Diabetes Institute for Immunology and Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Sutherland
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D000328:Adult; D000375:Aging; D002102:Cadaver; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery; D003924:Diabetes Mellitus, Type 2 / Q000601:surgery; D004322:Drainage / Q000379:methods; D006085:Graft Survival; D006650:Histocompatibility Testing; D006801:Humans; D007165:Immunosuppression Therapy; D007390:International Agencies; D016030:Kidney Transplantation / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D016035:Pancreas Transplantation / Q000706:statistics & numerical data*; D011309:Preservation, Biological; D012042:Registries; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States