title: Evolution of pancreas transplantation: long-term results and perspectives from a high-volume center.
abstract: OBJECTIVE
  To describe the evolution of pancreas transplantation from 1979 to 2011. The aim was to examine factors influencing long-term patient and graft survival, surgical methods, and risk factors influencing organ performance after transplantation.
  
  
  BACKGROUND
  Pancreas transplantation has become the therapy of choice for patients suffering insulin-dependent diabetes and end stage renal failure.
  
  
  METHODS
  Retrospective analysis of 509 consecutive pancreas transplants (442 simultaneous pancreas and kidney [SPK], 20 pancreas transplanted alone [PTA], and 47 pancreas transplanted after kidney [PAK]), performed at the University Hospital Innsbruck. The data were statistically analyzed using the Kaplan-Meier method and log-rank test.
  
  
  RESULTS
  After overcoming initial immunological and technical problems between 1979 and 1988 (5-year pancreas graft survival rate, 29.7%), pancreas transplantation evolved during the second decade (1989-1996; 5-year pancreas graft survival rate, 42.2%). Technical changes, optimized immunosuppression, careful pretransplant evaluation, and improved graft monitoring have become standard in the last decade and result in excellent 5-year patient (94.3%), kidney (89.4%), and pancreas (81.5%) graft survival. Five-year graft survival was superior in SPK (68.8%) compared with PAK (62.5%) and PTA (16.4%). SPK retransplantation can be carried out safely with 5-year patient (87.5%) and pancreas graft (75.0%) survival. Overall 5-year patient survival after loss of the first pancreas graft is significantly better in patients who underwent retransplantation (89.4% vs. 67.9%, P = 0.001). Long-term pancreas graft survival is independent of donor body mass index, sex, and cause of death, anastomosis time and the number of human leukocyte antigen (HLA) mismatches, recipient age, body mass index, sex, current panel reactive antibodies, and waiting time. Significant risk factors for reduced graft survival are cold ischemia time and donor age.
  
  
  CONCLUSIONS
  During the last 32 years, many problems in pancreas transplantation have been overcome and it may currently represent the therapeutic gold standard for some patients with diabetes and end stage renal failure.
authors.affiliation: Department of Visceral, Transplant and Thoracic Surgery, Medical University Innsbruck, Anichstrasse 35, Innsbruck, Tyrol, Austria. robert.oellinger@i-med.ac.at
authors.forename: Robert
authors.initials: R
authors.lastname: Ollinger
authors.forename: Christian
authors.initials: C
authors.lastname: Margreiter
authors.forename: Claudia
authors.initials: C
authors.lastname: Bösmüller
authors.forename: Annemarie
authors.initials: A
authors.lastname: Weissenbacher
authors.forename: Florian
authors.initials: F
authors.lastname: Frank
authors.forename: Stefan
authors.initials: S
authors.lastname: Schneeberger
authors.forename: Walter
authors.initials: W
authors.lastname: Mark
authors.forename: Raimund
authors.initials: R
authors.lastname: Margreiter
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
mesh_terms: D000293:Adolescent; D000328:Adult; D000704:Analysis of Variance; D001317:Austria / Q000453:epidemiology; D002423:Cause of Death; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D016035:Pancreas Transplantation / Q000379:methods / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate